On September 8, 2016, the Anesthesia Patient Safety Foundation (APSF) invited representatives of large anesthesia groups and practice management companies to meet with members of the APSF Executive Committee to discuss the patient safety implications of production pressures.

Thirty-five attendees representing 24 large anesthesia groups or practice management companies participated in the half-day session (Table 1). These 24 entities represented a wide geographical cross-section of the United States and a variety of practice models that included all categories of anesthesia professionals. The American Society of Anesthesiologists (ASA), American Association of Nurse Anesthetists (AANA), and American Academy of Anesthesiologist Assistants (AAAA) were also represented.

Table 1: Large Anesthesia Groups and Practice Management Companies Represented
Jimena Garcia	Baxter Healthcare
Timothy Vanderveen, PharmD	Becton-Dickinson
Ann M. Bilyew	ClearLine MD
Dan J. Sirota	Cook Medical
David Karchner	Dräger Medical
Leslie C. North, RN	Eagle Pharmaceuticals
Angie Lindsey	Fresenius Kabi, USA
Matti E. Lehtonen	GE Healthcare
Steven J. Barker, MD, PhD	Masimo
Richard L. Gilbert, MD, MBA	MEDNAX
Patricia Reilly, CRNA	Medtronic
Rachel A. Hollingshead, RN	Merck
Jeffrey M. Corliss	Mindray
Kathy Hart	Nihon Kohden America
John Di Capua, MD	North American Partners in Anesthesia (NAPA)
Joshua L. Lumbley, MD	NorthStar Anesthesia
Dustin R. Crumby, RN	Pall Corporation
TBD	PharMEDium Services
John C. Dalton, MD	PhyMED Healthcare Group
Steven R. Sanford, JD	Preferred Physicians Medical Risk Retention Group
Diana Gelston	Respiratory Motion
Andrew Greenfield, MD	Sheridan Healthcorp
Tom Ulseth	Smiths Medical
Andrew Levi	Spacelabs
Whitney Reynolds	Teleflex
Leona England Rice	The Doctors Company Foundation
Kristin Bratberg	US Anesthesia Partners
Casey D. Blitt, MD	APSF Treasurer
Mark A. Warner, MD	APSF President

As an introduction to the conference, Robert K. Stoelting, MD, APSF president, described the three options that he believes are available for APSF safety recommendations to become “best practices.” One option is for professional associations (ASA, AANA, AAAA) to adopt APSF safety recommendations in the form of policy statements (Practice Advisories) that would be applicable to all association members. A second option is “spreading the word” among individual anesthesia professionals via social media and educational materials (conference reports in the APSF Newsletter, APSF educational videos). A third option for effecting change and the principal reason to involve large anesthesia groups and practice management companies is APSF’s hope that these entities would individually endorse and adopt selected APSF safety recommendations that are relevant to their practices and resources. Dr. Stoelting proposed that “closing the loop” on APSF safety practices” represents an opportunity for large anesthesia groups and practice management companies to embrace relevant anesthesia patient safety initiatives advocated by APSF.

Following these introductory comments, the safety implications of production pressures were discussed with podium presentations by Drs. David M. Gaba, Samuel DeMaria, Mary Ann Vann, Myriam P. Garzon, and Brian J. Cammarata. Common observations from their presentations are summarized in Table 2.

During the final hour of the conference, attendees were divided into small groups to meet with members of the APSF Executive Committee to discuss four questions relevant to patient safety and production pressures. The comments and recommendations from the small groups are summarized in Table 3.

As the moderator of the conference and author of this report, I am taking the liberty of expressing a personal editorial viewpoint based on the small group comments to Question 4 (Table 3): Are there “production pressures” that have a recognized or potential positive impact on patient safety? As background, a front page article in the June 21, 2005, Wall Street Journal entitled, “Once Seen as Risky, One Group of Doctors Changes Its Ways,” observed, “Rather than pushing for laws that would protect them from patient lawsuits, these anesthesiologists focused on improving patient safety.” Perhaps, anesthesia professionals can turn the “negative knee jerk reaction to production pressures” into a patient safety opportunity by endorsing and following the small group responses to Question 4 (Table 3).

Large anesthesia groups and practice management companies in partnership with APSF have a unique opportunity to pursue our common goal that “no patient shall be harmed by anesthesia.”

 

Robert K. Stoelting, MD
Immediate Past President, APSF