Newsletter homeIn this edition

Abstract Deadlines

The abstract submission site for the 32nd Annual Meeting & Workshops opened July 20, 2009 and closes October 26, 2009 4 pm Eastern.
Please visit SCA's Events page for details.

FOR SCA FELLOW MEMBERS ONLY
SCA Annual Meeting – Fellow Program
Complex Case Submission Site will open November 2, 2009 and close December 18, 2009 on the SCA Website.

Drug & Innovation Update

Continuous Noninvasive Hemoglobin Measurement

Literature Reviews

Oral direct thrombin inhibitor AZD0837 for the prevention of stroke and systemic
embolism in patients with non-valvular atrial fibrillation: A randomized
dose-guiding, safety, and tolerability study of four doses of AZD0837 vs. vitamin
K antagonists

Safety and Efficacy of Recombinant Activated Factor VII
A Randomized Placebo-Controlled Trial in the Setting of Bleeding After Cardiac Surgery

Preoperative Hemoglobin Level as a Predictor of Survival After Coronary Artery Bypass Grafting: A Comparison With the Matched General Population

Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery:the NAPA Trial

Prevalence and Repair of Intraoperatively Diagnosed Patent Foramen Ovale and Association With Perioperative Outcomes and Long-term Survival

Foundation Update

The Society of Cardiovascular Anesthesiologists (SCA) Foundation Announces 2010 Research Grants


The Society of Cardiovascular Anesthesiologists (SCA) publishes the SCA Bulletin bimonthly. The information presented in the SCA Bulletin has been obtained by the editors. Validity of opinions presented, drug dosages, accuracy and completeness of content are not guaranteed by SCA.

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President's MessagePatient Safety, Leading the Way

Unless you are living under a rock, and in that case you will probably not see this message, patient safety is a very hot topic in the press, medical literature, and for most regulatory bodies. As a specialty, for the past 25 years Anesthesiology has aggressively pursued improvements in patient safety and has succeeded in reducing morbidity and mortality. These improvements have helped minimize real dollar increases in our malpractice costs.(1)

Other specialties and organizations are now following our lead. The World Health Organization is actively promoting a program entitled “Safe Surgery Saves Lives." (2)   One element of the program is a preoperative checklist and a post operative briefing. In a multi center, historical control, study published early this year, Haynes et al (3) observed a reduced morbidity and mortality rate after implementation of the enhanced communication. More recently Henrikson et al (4) reported on the utility of a preoperative briefing protocol in cardiac surgery as a means to improve patient safety and efficiency. They found that the briefing significantly reduced miscommunication errors from 2.5 to 1.17 per case. Clearly patient safety is an important issue, and as members of SCA we should be proud that our society is conducting a major patient safety initiative.

As I stated in my initial President’s Message, one of the key goals of my tenure is to “Continue to support the FOCUS Research Project and ensure its success. The FOCUS research project is the latest manifestation of the Society’s commitment to patient safety. This ground breaking project is rapidly gathering momentum and is very likely to soon offer real insight into intraoperative communication.” In this message, I have asked Dr. Bruce Spiess, Chairman of the FOCUS Initiative and champion of the project, to provide us with a status report on the project. I personally am very anxious to see how we are progressing and look forward to reading his report.

  1. Joseph Hallinan, Wall Street Journal June 21, 2005 Page A1
  2. www.who.int/patientsafety/safesurgery/en/
  3. NEJM Volume 360:491-499, Jan 29, 2009
  4. J Am Coll Surg 2009;208:1115–1123

FOCUS initiative is young, but shows potential to make a difference

Bruce D. Spiess, MD, FAHA
FOCUS Initiative Chairman

Over the past five years, through the dedicated efforts of many SCA members, FOCUS has grown from a concept to a maturing research/interventional initiative. Data gathering from the first five sites is complete, and the data is being processed. This enormous accomplishment represents a coming of age for the FOCUS Initiative, but our work has only begun! FOCUS is on track due to the efforts of all the members of the SCA, the SCA Foundation (especially Joyce Wahr and Nancy Nussmeier) and particularly SCA President Steve Konstadt for their interest, dedication and support. Thanks go as well to our SCA Foundation donors, the FOCUS Steering Committee members, and our FOCUS participating sites.

Of the many interested sites who volunteered to be an observational FOCUS site, five were chosen; over the past winter and spring these sites were visited by a team from the Johns Hopkins University Quality and Safety Research Group (JHUQSRG).

  1. Baystate Medical Center, Massachusetts
  2. Medical University of South Carolina, South Carolina
  3. New York University Medical Center, New York
  4. Lehigh Valley Medical Center, Pennsylvania
  5. St. Johns Medical Center, Missouri

The JHUQSRG team includes experts in human factors engineering, organizational sociology, cardiovascular clinical care, applied organizational psychology and health services research. This team has devised and tested sociologic and observational methodology in prior, published projects, and developed specific tools for this project. JHUQSRG has used the term “LENS” (Locating Errors through Networked Surveillance) prior to beginning their work with FOCUS. What luck that our two acronyms fit so well!

This initial data gathering phase consisted of surveys and interviews with team members at each of the five sites. In addition, direct case observations occurred, where a minimum of two cases were observed at each site in their entirety. Conclusions will come from 22 cases; despite the relatively small sample size, repeating themes are already evident. Hundreds of hours have been spent to code these data. The data is robust!

On August 13, 2009 members of the FOCUS Steering Committee and the JHUQSRG team met in Baltimore for an early look at the data. At this meeting we realized the goal of making FOCUS a cardiovascular team effort; we were joined by two Society of Thoracic Surgeons members (STS), as well as one each from the American Society of ExtraCorporeal Technology (AmSECT), the Association of Operating Room Nurses (AORN) and the American Society of Human Factors Engineers.  This multi-collaborative effort to improve patient safety is critical to the success of FOCUS—the importance and uniqueness of this accomplishment should be celebrated!

As preparation for the FOCUS initiative, the JHU team reviewed the literature and found that 37 papers had specific implications for FOCUS.  The themes found were:

  1. Small events do matter.
  2. Precursor culture and events are critical.
  3. Flow disruptions are important to the team.
  4. If you are not looking for the errors you will not see them.

The site surveys found a high level of individual motivation to improve outcome and to find ways to avoid error. The culture of patient safety was variable (but uniformly low) between institutions, and often, perceptions by leadership of the level of safety were in conflict with perceptions of frontline workers. Barriers in communication, rewards, and individual ability to report problems were uncovered. These themes will be the FOCUS of future interventions.

The direct observations showed themes of safety issues with devices (smart pumps, mobile and fixed monitors, anesthesia machines), physical layout and environment (limited workspace, poor layout, lack of planning and ergonomics), teamwork (distractions, poor situational awareness, poor communication in handoffs, lack of adequate briefings and de-briefings, poor understanding of tasks to be performed), and ambiguities (poor communication techniques, intimidation, lack of protocols). However, very good practices were observed, including appropriate supervision, vigilance and work sharing for tasks.

From the long day of data discussion the FOCUS Steering Committee and QSRG proposed prioritized work groups to develop interventions:

  1. To intervene and study safety culture in the OR using perioperative infection as a metric. This learning collaborative needs 10-20 sites; an Agency for Healthcare Research and Quality(AHRQ) grant will be submitted to fund this research.
  2. To develop peer-to-peer assessment tool for individual cardiac programs to assess their own culture of safety, communication, etc. This will require development of tools and 10-50 sites for testing of tools and interventions.
  3. To work on ergonomics of the operating room as a whole; involve industry and human factors’ planners in redesigning cardiac rooms for best performance.
  4. To develop briefing and debriefing communications of the entire OR team. A standardized “best practice” initiative will be proposed and tested.
  5. Drug errors were not directly observed; however, the NHS database notes them as does the literature. FOCUS is already collaborating with the Anesthesia Patient Safety Foundation (APSF) to reduce medication errors.

Publications are already underway, with two visionary papers submitted to Anesthesia & Analgesia. Methodology papers concerning the observational visits are in progress. Data from the observational visits will be analyzed and presented over the next few months.

This is the time for SCA members to become more involved! At the ASA, FOCUS interested individuals will be invited to hear about future participation in work groups and sites for the next studies (Contact johnm@scahq.org for details). Future work will need to be supported by grants and donations; young careers can be supported and advanced within the FOCUS framework.

FOCUS has gained success through SCA members’ generosity and philanthropy; in addition, individual SCA members have added significant personal contributions. We hope our shareholder collaborators will join us in this effort; however, your efforts will significantly influence patient safety.  You make a difference!

FOCUS is young, yet it has matured. It has the potential to truly make a difference. In the next months and years, FOCUS will become a force for change in our lives and it will save lives! The SCA has led with the investigation of human errors; now it will improve safety through teaching and intervening.

Thank you again to each of the SCA members for their enthusiasm, and to our leadership for the insightful backing that is now and will be making FOCUS a huge success for our patients’ future. The cause has charisma – join us!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

©2009 Society of Cardiovascular Anesthesiologists
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