A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
The refrigerated trucks had not yet left our parking lot when I got an email from the IT department. It was late spring 2020, and deploying a new electronic health record system for the anesthesia department was not front of mind. We had been working at adapting Epic for intraoperative record-keeping at the University Hospital in Newark, New Jersey for months, but I had assumed the project would be on hold due to COVID-19. Yet there in my inbox was the timeline set forth by IT and our Epic liaison saying that our go-live date was still set for August 2020. At first, I was really taken aback. Our operating rooms were closed to elective surgeries for what felt like an eternity. The recovery room was a makeshift ICU, and seemingly every unit was converted to an isolation ward. Yet there we were talking about implementing a new computer system. Was this the most valuable use of our time in the middle of a global pandemic?
In the best of times, it can be hard to focus on reviewing hospital policies and procedures, educating clinical personnel, and reviewing adverse events, even when patient safety is top of mind. As the director of quality assurance in the Department of Anesthesiology at Rutgers New Jersey Medical School, it’s my responsibility to keep our focus on patient safety, which became infinitely harder when COVID-19 hit. Even before then, it would often take repeated emails, reviews during grand rounds, and discussions at faculty meetings and resident lectures to implement any changes in policies or procedures. I knew that when the pandemic hit, my job would get even harder. At first, it was exceedingly difficult to determine where the methodical work of patient safety fit in terms of prioritization, with the world seemingly changing every minute.
Nonetheless, our Epic project was not only continuing, but the plan was to stick to our original timeline and deploy intraoperative record-keeping for anesthesiology by the end of the summer. Our meetings shifted to virtual conferences once or twice a week, and my emails and texts were taken over by communication with IT, Epic, and computer infrastructure personnel. Here we were on the clinical side of operations trying to create perioperative safety guidelines for patients in the midst of the pandemic, and meanwhile I’m reviewing workflows for intraoperative documentation. The exhaustive work of patient safety persisted.
Before long, we resumed elective surgeries, albeit with new guidelines and restrictions, and departmental complications began rolling in again. Our anonymous, hospital-wide safety reporting system continued churning out alerts that I had to examine, and our Quality Assurance Committee resumed its regular monthly reviews. We still had patient safety metrics to continue to report and educational sessions to plan. We held mock codes and discussed blood management algorithms. We constantly worked to improve our intraoperative electronic documentation system and hold weekly meetings for Epic, and still do today, to continue to strive for opportunities for improvement.
In truth, there were a few months where I thought the world would never be the same again, and quite frankly it probably never will be. But some things do remain the same, and the work we do for patient safety never stopped being critical. Every patient who walks into the hospital is at risk for a line infection or transfusion reaction despite the pandemic, and every patient deserves a safe perioperative experience. Our care teams’ routine work of meeting to review adverse complications, convening for root cause analysis when a catastrophic event occurs, and compiling patient safety data doesn’t make the news. It is not often at the forefront of our minds when worrying about our kids, friends, family and community health. Still, it is paramount to advancing patient safety and making strides toward eliminating complications.
When the Omicron surge hit at the end of 2021, it wasn’t peculiar to me to be discussing a root cause analysis for a patient who had a catastrophic outcome in the vascular angiography suite, considering our prior experience. It is just what we had to do. As long as we are providing anesthesia services, patients will continue to have routine complications, such as laryngospasm, difficult intubations, and post-dural puncture headaches. These complications always present learning opportunities for the clinicians involved and for our faculty and staff when reviewed. When we find those complications that have systemic causes, we must address them to prevent any further calamitous perioperative events. This work is vital to the ongoing goal of preserving and improving patient safety, and deserves even further effort.
Since the start of the pandemic, I’ve done my best to expand our patient safety practices and reviews. We still have our bi-monthly morbidity and mortality grand rounds, but now every month I review all of the complications with the residents in a dedicated lecture. We also hold a bi-monthly workshop where we review every documented difficult airway. Our simulation program focuses on preparing residents for the most strenuous situations, not only for educational purposes, but to improve the quality of our patient care.
So here I sit in my office, a virtual meeting on my screen for the Perioperative Quality Subcommittee, and a stack of spreadsheets on my desk. I have dozens of safety reports to address, meetings to prepare for, and educational sessions to schedule. However, this week during Patient Safety Awareness Week, I am reminded that although we may vacillate between various COVID-19 guidelines and standards, the essential work of patient safety continues as we chase our goal of eliminating the risk of patient harm. Even during an unprecedented crisis, we must ensure that our priorities align with this objective.
George Tewfik is an anesthesiologist.
Image credit: Shutterstock.com
