The Anesthesia Patient Safety Foundation (APSF), now in its 18th
year, continues in its mission to encourage activities that will
prevent patients from being harmed by the effects of anesthesia.
Long-standing activities such as the APSF newsletter, research
grant awards and the Web site are alive and well. Support from
ASA, its component societies and its membership as well as from
industry continues. We thank you all.
Currently, major attention is being paid to the role of automated
information management systems (AIMS) in promoting patient safety.
The APSF Board of Directors approved the following at its 2001
Annual Meeting: "The APSF endorses and advocates the use
of automated record-keeping in the perioperative period and the
subsequent retrieval and analysis of the data to improve patient
safety." This position was developed following APSF board
retreats in 2000 on perioperative data management and in 2001
on the role of AIMS in improving morbidity and mortality conferences.
The Summer 2001 APSF Newsletter that devoted an entire issue to
information systems can be found on the Web site.
It has become obvious that there is need for a common nomenclature
to be available in comparing perioperative information and outcomes.
Therefore, APSF has appointed a Data Dictionary Task Force (DDTF),
chaired by Terri G. Monk, M.D., of the University of Florida,
Gainesville, Florida. The role of the task force will be to:
- Identify a common language of specific perioperative terms
- Define a minimum set of data elements necessary for a perioperative
information management system
- Standardize the data elements as a first step in building
a national outcomes database dedicated to the identification
of causes and prevention of anesthetic morbidity and mortality.
Members of the task force include a number of well-known anesthesiologists
who are knowledgeable in the field of information management (see
"Data Dictionary Task Force" on the APSF Web site).
In addition, a technical working group has been established made
up of experts from the several corporations involved in designing
information systems. Iain C. Sanderson, M.D., of Duke University,
Durham, North Carolina, is the chair. Ronald A. Gabel, M.D., chair
of the ASA Committee on Performance and Outcomes, sits with both
groups.
APSF President Robert K. Stoelting, M.D., has noted, "A
common data set allows for the collection and comparison of large
volumes of clinical data from multiple institutions for outcomes
research and benchmarking."
A seed grant from APSF provided initial financial support for
this undertaking, and contributions from each of the corporate
participants are now funding it. These participants include Deio;
Draeger Medical, Inc.; eko systems, Inc.; GE Medical Systems;
Philips Medical Systems; Picis; and Siemens Medical Solutions.
Initially, the DDTF will focus on the leverage of existing standards
and lexicons as well as collecting and comparing data elements
from installed clinical information systems to determine the common
terms.
Dr. Monk has commented that, "Paper-based medical records
do not facilitate the reliable and efficient transfer of medical
information between health care facilities and providers. Computer-based
patient records provide better interfaces between clinical data
and health care providers… At the present time, the several
computer-based anesthesia records in use lack the ability to interface
with each other or with a central data depository. The retrieval
of information is also limited by inconsistencies in the naming
of problems, medications and other data." Hence, the first
step will be the creation of a data dictionary for the data elements
required.
Use of AIMS is supported by many organizations, including the
Institutes of Medicine, as a necessary undertaking in promoting
further patient safety.
The task force is approaching the problem of sharing data from
a different perspective, recognizing that the primary problem
is the lack of a standard terminology. APSF intends to make the
results readily available to the entire anesthesiology community.
Dr. Sanderson expects that a preliminary reference data set will
be available for review in October 2002 at the time of the ASA
Annual Meeting.
Certainly, in my view, use of automated anesthesia information
management systems is a most important step in promoting patient
safety now and in the future. With efforts on the part of APSF
and DDTF, we hope that over the next several years, installation
of these systems will increase dramatically from the current usage
– about 3 percent of U.S. hospitals. This increase in usage
will allow more anesthesiologists to review recent anesthesia
and surgical incidents in sick patients, such as diabetic individuals,
before proceeding with anesthesia for follow-up surgery. If your
automobile repair shop can tell you the history of oil changes
in your vehicle, certainly your anesthesiologist should be able
to determine your history with anesthetics.
ASA members are encouraged to follow the activities of the DDTF
through the APSF Web site.
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Ellison
C. Pierce, Jr., M.D., is a member of the Committee on Patient
Safety and Risk Management. He is currently retired from practice. |
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