Perfect weather redoubled the fun for the anesthesiologists and their families who attended the CSA’s Annual Anesthesia Meeting & Workshops, held in San Francisco from April 14 to 17. The Hyatt Fisherman’s Wharf proved to be a delightful venue, with shops, restaurants, and the famous Ghirardelli Square within a few blocks of the hotel. Nearly 20 percent of the attendees were from outside California, and six percent traveled from other countries for the occasion.
Johanna Schwarzenberger, MD, of the University of California, Los Angeles, chaired the program, and organized it admirably with her team. The program began with three concurrent pre-conference workshops on Thursday afternoon, providing hands-on, small group teaching. Kristine Breyer, MD, led the workshop on perioperative ultrasound and echocardiography, while Vivek Kulkarni, MD, PhD, and his colleagues provided clinical scenarios for training in thoracic anesthesia. Ed Mariano, MD, MAS, the CSA’s Assistant Speaker of the House, and his group focused on techniques of ultrasound-guided nerve blocks with an emphasis on avoiding common pitfalls and ensuring patient safety.
Anna Varughese, MD, MPH, delivered this year’s Leffingwell Honorary Lecture—named for Forrest Leffingwell, MD, who was one of the founders of the CSA, our second president, and later served as President of the ASA. This talk is a highlight of every CSA annual meeting, and Dr. Varughese chose as her topic “High Reliability Organization: How to Transform Your Operating Room.”
Dr. Varughese is the Anesthesia Divisional Chief and Senior Medical Director for Perioperative Services at the Cincinnati Children’s Hospital Medical Center. She told the audience that the World Health Organization now estimates that 250 million operations per year are performed world-wide, resulting in about seven million surgical complications and one million deaths each year.
“We can learn a lot from aviation,” Dr. Varughese said. Both are complex industries with lives at risk, she said, and in both fields trained professionals must work together to achieve safe results. “But planes are machines that tend to act the same way every time,” she said, “and human beings don’t.”
Dr. Varughese described how her hospital evaluated its processes to improve reliability, quality and efficiency after a serious adverse event. On an especially busy day, a different slush machine was brought into an operating room because the other machines were all in use, and the team wasn’t as familiar with it. Irrigation fluids were accidentally contaminated with isopropyl alcohol, resulting in the death of an infant from multiple organ failure three days later. The hospital had tended to assume that experience equaled competency, she said, and education on new equipment often happened “on the fly” with a product representative.
“We interpreted skill at work-arounds and daily ‘fixes’ as an inherent sign of safety and competency,” Dr. Varughese explained, but small problems and near misses suggest the possibility of bigger unrecognized problems. Small errors should be interpreted as a symptom that something is wrong, she said. Teamwork training, the use of simulators, and continuing briefings and debriefings were implemented to standardize team performance.
The anesthesia department can play a key role in making the hospital a high reliability organization, Dr. Varughese said, defining high reliability as success in avoiding catastrophes in an unforgiving environment where accidents can be expected due to risk factors and complexity. She cited nuclear power facilities, commercial aviation, and firefighting as other examples of unforgiving environments where learning through experimentation is not an acceptable option.
Dr. Varughese said her hospital’s experience can serve as an example of how we as anesthesiologists should take leadership roles in hospital-wide patient safety initiatives. She and her colleagues created five perioperative microsystems that grouped specialties together. They developed definitions of key processes, and created a mechanism to provide automatic escalation of help and resources when circumstances demand it.
“To do things differently, we must see things differently,” Dr. Varughese concluded, quoting John Kelsch, the former director of quality for Xerox Corporation. “When we see things we haven’t noticed before, we can ask questions we didn’t know to ask before.”
The meeting featured lectures and problem-based learning discussions (PLBDs) of the highest standards, presented in concurrent sessions from Friday to Sunday. New literature was presented in a critical manner to make it accessible and useful to the attendees. There was an emphasis on interdisciplinary learning and on thought-provoking topics for advancing the care of our patients. All the faculty members were national experts in their fields.
The plenary sessions featured lectures organized by subspecialties. The session topics included neuroanesthesia, critical care, geriatric anesthesia, pain, obstetric anesthesia, pediatric anesthesia, regional anesthesia, cardiac anesthesia, quality, acute care medicine, emerging roles for anesthesiologists, and transplant/organ failure. PBLDs were presented simultaneously in a different room. They facilitated small-group learning and exchange of ideas and experiences. There was opportunity to learn about new trends in anesthesiology, perioperative medicine, and hospital-wide management.
CSA is working to make our annual educational meeting a world-class opportunity to learn about new developments in anesthesiology. Next year’s meeting will also be held at Hyatt Fisherman’s Wharf, from April 27 to 30, 2017.
The CSA extends sincere thanks to the 21 corporate exhibitors who staffed booths and exhibited at the educational meeting:
Anesthesia Business Consultants
B. Braun Medical Inc.
EzCall, A Kronos Solution
First Capitol Benefit Advisors
The American Board of Anesthesiology
The Doctors Company
The Medicines Company