In a hushed surgical theater in Boston in 1846, anesthesia changed medicine forever. The first successful public demonstration of ether anesthesia allowed patients to undergo surgery they would otherwise not have been able to tolerate. Previously, patients who had been subjected to biting down on cloth or looking into a blue light could finally undergo surgery with a real anesthetic, with no pain or recall.
The advancement of the medical specialty of anesthesiology by physician anesthesiologists over the last 168 years has dramatically improved surgery and medicine as a whole. In 2012, readers of the esteemed New England Journal of Medicine declared an article on the discovery of ether anesthesia in 1846 the most important story in the journal’s 200-year history. Physician anesthesiologists and the American Society of Anesthesiologists® (ASA®) have developed new techniques and innovations in anesthesiology decade after decade, leading to better patient outcomes, improved safety and satisfaction.
Fast forward from 1846 to 1984, and the specialty of anesthesiology was undergoing major changes. In that year, after establishing the ASA Committee on Patient Safety and Risk Management, then ASA President Ellison C. Pierce Jr., M.D., became the first president of the Anesthesia Patient Safety Foundation (APSF), a nonprofit organization founded to improve patient care through research and education. The APSF has since sponsored research to, among other important developments, look into the growing number of office-based procedures and the safety of patients undergoing them. In 1986, ASA was the first medical specialty organization to focus on patient safety. It adopted standards of care for its members, a measure that led others in the house of medicine to follow suit. Now, ASA has more than 30 standards, guidelines and statements address patient care before, during and after surgery and invasive procedures.
In 1999, the Institute of Medicine report “To Err is Human” singled out the medical specialty of anesthesiology for its significant improvements in patient safety. “Few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety. Although it is believed that the commitment exists among their members, there has been little collective action. The exception most often cited is the work that has been done by anesthesiologists to improve safety and outcomes for patients.”
In 2008, ASA formed the Anesthesia Quality Institute (AQI), which maintains the National Anesthesia Clinical Outcomes Registry (NACOR) and in 2014 NACOR became a Qualified Clinical Data Registry by the Centers for Medicare & Medicaid Services (CMS). The registry has collected data from nearly 22 million cases from electronic health records, using it to measure clinical outcomes (e.g., post-operative nausea and vomiting) and efficiency outcomes (e.g., surgery cancellations). According to Richard Dutton, MD, executive director of AQI, the registry essentially holds up a mirror to the specialty, showing physician anesthesiologists what they can improve upon and what gaps they can close. So far, participants of the registry have shown steady performance improvement. One study based on NACOR data shows that anesthesia complications decreased by more than half from 2010 to 2013.
AQI has revolutionized the way physician anesthesiologists see outcomes in care. But ASA has taken patient care another leap forward with the perioperative surgical home (PSH). PSH is the patient-centered model of care that aims to improve health, improve the delivery of health care and reduce the cost of care. The model is designed to address perioperative care that is fragmented and variable, and replace it with seamless continuity for the surgical patient. In 2014, ASA launched the PSH learning collaborative, a structured network of 44 health care organizations implementing PSH models that share best practices and experiences. These organizations are currently working to define the model, pilot it, and assess whether it proves superior to conventional perioperative care. Preliminary findings from PSH models at the University of California Irvine, Kaiser Permanente and the University of Alabama found improved patient outcomes and efficiencies.
Physician anesthesiologists are leaders in the operating room (O.R.), but their role has expanded into nonsurgical settings too, as the number of complex invasive procedures has increased. As leaders in quality management, physician anesthesiologists are applying safety processes such as evidence-based medicine, standardized policy and procedures, checklists and surgical care practices to procedures outside the O.R., leading to improved quality and safer care.
In addition to all of the advances in anesthesia care, physician anesthesiologists also recognize one of the most important elements of care: communication between the patient and their physician. In September 2014, ASA issued a statement noting the critical conversations patients must have with their physician anesthesiologists about their anesthesia care delivery plan. These conversations are imperative to safe, high-quality care.
Physician anesthesiologists have adapted to the changing landscape of health care over time, and now serve as not only innovators and experts in the fields of anesthesiology, critical care and pain medicine, but also as leaders in patient safety and overall quality of care. Physician anesthesiologists are medical experts who save lives when seconds count, but they are also advocates for patients, in and out of the O.R.
The history of anesthesiology and ASA is steeped in innovation that has brought better care to patients. The specialty was the first to champion patient safety, and while the work is by no means done, ASA is making great strides to ensure that all patients receive the safest, high-quality care.
John P. Abenstein is president, American Society of Anesthesiologists.
