APSF Ellison C. Pierce Lecture on Patient Safety

Towards Patient Safety in Anesthesia – Let the Journey Continue

Saturday, October 12, 2013
1 - 2 p.m. (New Time)

Alan F. Merry, M.B., Ch.B, FANZCA, FRCA

Dr. Alan Merry practices anesthesia and chronic pain management at Auckland City Hospital, and is head of the School of Medicine at the University of Auckland. He is a councilor of the Australian and New Zealand College of Anaesthetists, deputy treasurer of the World Federation of Societies of Anaesthesiologists and chair of the Board of the New Zealand Health Quality and Safety Commission. Dr. Merry is on the Board of Lifebox, an international charitable initiative to improve standards of surgery and anesthesia in low-income areas of the world. His three books, 17 book chapters and over 120 papers in peer-reviewed journals reflect interests in human factors, patient safety and simulation. He established the spinal cord stimulation service within the Auckland Regional Pain Service, and has a particular interest in using spinal cord stimulation to manage chronic intractable angina pectoris.

Few people can equal the contribution of Ellison C. ( 'Jeep' ) Pierce to the dramatic improvement in the safety of anesthesia that characterized the second half of the 20th century in high-income countries. This improvement means that, today, anesthesiologists in well-resourced areas of the world can truthfully inform young people having minor to moderate day surgery that the risk of dying from anesthesia is very low indeed. However, recent data cast doubt on the validity of conveying similar reassurances to older people, who may have cardiovascular disease, undergoing procedures that require at least one night in the hospital. From a patient’s perspective, it makes little difference whether risk arises from patient-related, surgery-related or anesthesia-related factors. Furthermore, data about mortality within 24 or 48 hours of surgery are likely to be of little interest. Most patients simply want to know the likelihood they will go home in good health after their surgery and then stay well for a reasonable length of time.

If anesthesiologists can promote a more integrated and patient-centered approach to perioperative care than hitherto, working more in concert than in parallel with surgeons and the entire perioperative team, then over the coming half-century, the way we inform patients will change, and more importantly, outcomes will improve for a substantial proportion of our patients.

Jeep Pierce was outspoken about safety and about driving improvement in anesthesia, regardless of any political or other pressures to the contrary. His example provides all the inspiration needed for anesthesiologists to carry on their leadership in advancing patient safety. Let the journey continue until no patient is harmed by anesthesia!