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APSF: Improving Information Systems for the Safety
of Our Patients
Ellison C. Pierce, Jr., M.D.,
Executive Director
Anesthesia Patient Safety Foundation
It is a pleasure to be asked to write an article on
recent activities in the Anesthesia Patient Safety
Foundation (APSF). This will be my last review since
I am retiring as executive director this December.
Robert K. Stoelting, M.D., will assume the responsibilities
of the position as well as remain president. Bylaws
changes have established a new position, executive
vice-president, who will assist the president as an
advisor in the day-to-day management of APSF.
For the fourth year, APSF held a board retreat during
the 2002 ASA Annual Meeting, the title of which was
“Advancing the Use of Information Systems to
Improve Patient Safety.” Michael O’Reilly,
M.D., of the University of Michigan, developed the
program. As you may remember, APSF voted in 2001 to
endorse and advocate the use of automated record keeping
in the perioperative period and the subsequent retrieval
and analysis of the data to improve patient safety.
Among the topics discussed at the retreat were return
on investment, implementation, data, quality improvement
and legal issues. Important points made were that:
| • Such systems can vastly improve operating
management and efficiency; |
| • Written paper anesthesia records are
very often inaccurate; |
| • There are close connections between
interoperative events seen on the automated
record and outcomes; and |
| • These systems improve quality assurance
management. |
The strong conclusion was that electronic record keeping
is beneficial for business and other management issues,
but it is most important as a safety undertaking.
A review of the conference may be found in the Winter
2002-03 APSF Newsletter at <www.apsf.org>.
At the retreat, Iain C. Sanderson, M.D., Duke University,
discussed the current status of the Data Dictionary
Task Force (DDTF), a review of which also may be found
in the Winter APSF Newsletter. Dr. Sanderson
is the informatics expert for the project.
As of today, DDTF development continues to proceed
rapidly. DDTF has been designated as the lead organization
for Systematized Nomenclature of Medicine’s
(SNOMED) Convergent Terminology Group for Anesthesia.
This appointment signifies acceptance of DDTF methodology
in the development of a reference data set of anesthesia
terms. The structure of SNOMED will allow the ongoing
development of North American anesthesia terms in
an established process that features semiannual releases
updating its database. SNOMED is developed under the
auspices of the College of American Pathologists.
For more information, visit <www.snomed.org>.
DDTF, which is chaired by Terri G. Monk, M.D., from
the University of Florida, was created by APSF in
2001. This task force is an international effort with
collaboration from ASA (ASA Committee on Performance
and Outcomes Measurement), the Canadian Anesthesiologists’
Society and the National Health Service Information
Authority (United Kingdom).
SNOMED terms are integrated into hospital and clinical
information systems, including anesthesia information
management systems, to standardize patient data. This
standardization through the use of a convergent terminology
accommodates regional variation in terms but allows
data comparability. SNOMED development features a
review by subject matter experts, the convergent terminology
groups and a well-established mapping process managed
across specialty areas. The designation ensures the
integration of anesthesia terms into this standard
lexicon used by health care systems, such as Kaiser
Permanente and clinical information systems manufacturers,
including members of DDTF. A list of participating
vendors is found on the APSF Web site.
For the 19th year, APSF has awarded grants for patient
safety research. The first was to Kenneth B. Johnson,
M.D., Assistant Professor of Anesthesiology at the
University of Utah. The title of his project is “Exploration
of Partial Task and Variable Priority Training to
Improve Management of Adverse Respiratory Events:
An Enhanced Approach to Didactic and Simulation-Based
Training for Anesthesia Residents.” The second
was to Nyamkhishig Sambuughin, Ph.D., Assistant Staff
Scientist of Neurology Research at the Barrow Neurological
Institute, St. Joseph’s Hospital and Medical
Center, Phoenix, Arizona. The title of her project
is “Development of Molecular Diagnosis for Malignant
Hyperthermia.”
The APSF has helped to fund the development of the
virtual anesthesia machine (VAM) program and APSF
workbook, which were created by Samsun Lampotang,
Ph.D., at the University of Florida. The VAM is a
superb tool for learning how an anesthesia machine
works, especially for the beginning resident. Its
exhibition at the ASA Annual Meeting last year brought
many visitors to the APSF booth. More information
on the VAM can be found at <www.anest.ufl.edu/vam>.
A new initiative of APSF is the promotion in medicine
of the concept of a high reliability organization
(HRO), as applied in aviation, the military and industry.
The initial focus will be on the operating room and
other perioperative areas where the concept will be
especially appropriate. The Spring 2003 issue of the
APSF Newsletter was devoted to this subject
and includes a thorough analysis of HRO theory and
practice. See the APSF Web site for more details.
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Ellison
C. Pierce, Jr., M.D., is Executive Director
of the Anesthesia Patient Safety Foundation.
He is currently retired from practice. Dr. Pierce
was ASA President in 1984. |
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