IAC Emerging Topics in Patient Safety

By: Monica W. Harbell, M.D.; Fred E. Shapiro, DO, FASA

updated May 5, 2020

Human Factors and the Impact on Patient Safety: Tools and Training
R. Christopher Call, M.D., Keith J. Ruskin, M.D., Donna-Ann Thomas, M.D., and Michael F. O’Connor, M.D.

Over the past 20 years, a hierarchy of effective responses to failures in medicine has evolved, and is reviewed in this chapter. This same experience resulted in the creation of RCA 2.0, which will replace classical Root Cause Analysis for medical accidents.

Impacting the Next Generation: Teaching Quality and Patient Safety
Monica W. Harbell, M.D., Melanie Donnelly, M.D., Rahul Rastogi, M.D., MBA, and Jeffrey W. Simmons, M.D.

VALUE is the future of medicine. Anesthesiologists must provide efficient care at lower costs with superior quality care and the highest degree of safety. To keep on the cutting edge, anesthesiologists need to become experts in quality improvement (QI) and patient safety (PS). We address new ways to incorporate QI and PS into anesthesia residency curriculum, as well as practical methods for faculty development.

Screening and Diagnosing Frailty in the Cardiac and Noncardiac Surgical Patient to Improve
Safety and Outcomes
Ana Acosta, M.D., Myriam P. Garzon, M.D., MBA, and Richard D. Urman, M.D., MBA

Frail surgical patients have increased post-operative morbidity and mortality, length of hospital stay, and rates of discharge to rehabilitation facilities. As perioperative physicians, It is imperative that we focus on interventions that improve the functional status, safety and postoperative outcomes of frail patients. We will review the current state of research on frailty and patient safety, as well as spotlight areas in need of further research.

Communication: Is There a Standard Handover Technique to Transfer Patient Care?
Emily Methangkool, M.D., MPH, Luis Tollinche, M.D., Jamie Sparling, M.D., and Aalok V. Agarwala, M.D., MBA

Handovers of patient care include transfers of information and professional responsibility, but can be complicated by breakdowns in communication. Standardization of handovers may be key to avoiding omission of vital information. This article discusses challenges in effective communication during handovers, as well as the process or standardizing and implementing the perioperative handover.

Medication Safety in Anesthesia: Epidemiology, Causes, and Lessons Learned in Achieving Reliable Patient Outcomes
Raymond L. Cooper, M.D., FASA, Patricia Fogarty-Mack, M.D., Henry R. Kroll, M.D., and Paul Barach, M.D., MPH

Patients continue to suffer from medication errors despite 40 years of research calling for increased attention to medication safety. Read on to learn how the American Society of Anesthesiologists are actively working to engage the anesthesia community in preventing medication errors.

Building a Culture of Safety: Relearning Organizational Behavior
Peter A. DeSocio, DO, MBA, CPE, FASA, Myriam P. Garzon, M.D., MBA, and Michael R. Hicks, M.D., MBA, MHCM

Twenty years ago, medical errors were the 8th leading cause of patient deaths, and, despite advances in medicine, medical errors are now the 3rd leading cause of patient deaths, with human error as the major contributing factor. Rather than attempting to correct for human error on a case-by-case basis, the authors posit that developing a sustainable, evolving culture of safety would serve as a longstanding solution and lead to higher reliability within the medical field. Read on to discover how to develop a sustainable culture of safety within your organization.

Workplace Violence Against Anesthesiologists: We are not Immune to this Patient Safety Threat
Mercy A.Udoji, M.D., CMQ, Ifeyinwa C. Ifeanyi-Pillette, M.D., FASA, Thomas R.Miller, PhD,MBA, and Della M. Lin, MS,M.D., FASA

To date, there has not been a survey of the prevalence of workplace violence among anesthesiologists. This chapter will provide an overview of workplace violence, connect its importance to patient safety, and share results of a prevalence survey conducted in the fall of 2018 where >2500 anesthesiologists responded -- 20% reported experiencing physical violence and 69% reported experiencing non-physical violence in the workplace.

Cognitive Aids: Does Patient Safety Depend on a Manual?
Aalok V. Agarwala, M.D., MBA, Spiro G. Spanakis, DO, and Heather Nixon, M.D.

Cognitive aids and checklists are useful tools for improving communication and reducing adverse events during complex, high-stress situations. Successful implementation of cognitive aids into practice requires thoughtful planning with buy-in from leadership and frontline clinicians, customization, education, training, and anticipation of barriers. Read on to learn about the significant patient safety benefits of integrating cognitive aids into perioperative practice...

Distraction in the OR: Bells and Whistles on Silent Mode
Sara Neves, M.D. and Roy G. Soto, M.D.

Distraction can impact patient and public safety. While prevalent in all aspects of healthcare, distraction in the operating room (OR) has more immediate and severe consequences. In this article, we will discuss how the complex perioperative environment can lead to distraction and potential patient harm, compare the healthcare field to other industries facing similar problems, and suggest improvements to enhance patient safety.

Can Simulation Improve Patient Outcomes?
Steven Young, M.D., David Dunipace, C-AA, Erin Pukenas, M.D., and John Pawlowski, M.D.

Using simulation, trainees can be exposed to new situations, practice technical skills and meet challenging patients in a non-threatening environment. Both trainees and experienced anesthesiologists can learn about errors and strategies to prevent and mitigate their consequences. As new procedural technologies develop, there will be an increasing need to simulate these experiences before the first encounter with a patient.

Preserving Perioperative Brain Health Through a Patient Safety Lens
Christina A. Riccio, M.D., Amy C. Lu, M.D., and Della M. Lin, MS, M.D., FASA

Preserving perioperative neurocognitive disorders is an emerging concept in patient safety and the American Society of Anesthesiologists (ASA) Brain Health Initiative has propelled this work to the forefront for both anesthesiologists and the public. In this chapter, we provide a condensed background review, offer best and practices and then help readers prioritize and decide what can be successfully implemented in their organizations through a safety science lens.

Burnout, Wellness, and Resilience in Anesthesiology
Joseph F. Answine, M.D., FASA, Amy C. Lu, M.D., MPH, and Tal S.M. Levy, M.D., MBA

Physician burnout is defined by physical and psychological exhaustion, detachment from the job and a poor sense of self worth. Anesthesiologists and indirectly, their patients, are at risk leading to reduced patient satisfaction and poor outcomes. We review how the utilization of mindfulness and other wellness techniques can benefit physician anesthesiologists and patients.

Decision Aids: The Role of the Patient in Perioperative Safety
Warren A. Southerland, M.D., Luis E. Tollinche, M.D., and Fred E. Shapiro, DO, FASA

Patient decision aids help patients make informed choices by utilizing shared decision-making and increase patient engagement by incorporating patient’s individual values and preferences. This chapter discusses the future of patient decision aids in the field of anesthesia, including the implementation of a mobile phone “app” as a vehicle for the Monitored Anesthesia Care (MAC) decision aid, created by the ASA Committee on Patient Safety and Education.