Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. We are continuing our coverage of the International Conference on Anesthesia Patient Safety 2024. Were you in Tokyo for the conference? If not, this podcast series is bringing you insider coverage of the event. We hope that you have checked out episodes #190, 191, and 194 for the first three episodes in our ICAPS series. We are back for the fourth episode in this series today.
Before we dive into the episode today, we'd like to recognize BD, a major corporate supporter of APSF. BD has generously provided unrestricted support to further our vision that "no one shall be harmed by anesthesia care". Thank you, BD - we wouldn't be able to do all that we do without you!"
Conference Day 2 opens with the Keynote Speech, Japan Federation of Anesthesiologists: Healthcare Administrator's session. The first speaker is Katsunobu Kato, the former Minister of the Health, Labour, and Welfare to discuss, “Covid-19, from the Japanese Government Perspective on Protecting the Japanese Population. This talk highlights the impact of economics, the pandemic, and population trends on healthcare. In Japan, one the pressing issues is the increasing population of people over the age of 65 years old. There is also a decline in the working age population between 15-64 years old. Both of these changes will impact healthcare, but there is still a goal to maintain and improve vitality and increase healthy lifespan by at least 3 years by the year 2040. With the concern for a shortage of the labor force, there also needs to be a shift to thinking about how to address work-life balance and incorporate technology to increase productivity. Kato highlights the importance of reforming the way doctors think to address the problem of long working hours with a cap on the number of hours doctors can work. Going forward, it is imperative to enable all medical professionals to take advantage of all of their abilities to respond proactively with the goal to provide quality and safe medical care in a sustainable way. Looking at anesthesiologists in Japan, the total number has increased by 30% compared to 10 years ago, but the demand for anesthesia care is growing and this includes labor and delivery care.
The next speaker for this session is Eiko Ueda giving a talk on, “Trends in Medical Safety Measures in Japan and Medical Safety in the Perioperative Period.” First, here is an overview of perioperative medical safety in Japan. In 1999, a patient mix-up surgery occurred at a university leading to the creation of a study group and a committee report listed specific accident prevention measures related to preoperative visits, transporting patients, patient identification, patient handover, managing the operating room environment, starting anesthesia, and for incorporating strategies in the surgical department. One of the important action items was the institutionalization of a safety management system for special function hospitals with an in-hospital reporting system for accidents, committee meetings, development of safety management guidelines, and staff training. In 2001, there was a review meeting with the theme that everyone makes mistakes which marks a shift from focusing on the efforts of individual healthcare workers to keep patients safe to making the entire system safer and improving the quality of individual elements.
Let’s look a little closer at the Medical Accident Information Collection Project, which was started in 2015, to analyze and provide information about accident and near-miss incidents collected from medical institutions with the ability to share information with medical institutions as well as to disclose information to the public. For this project accidents include cases in which it is clear that incorrect medical care was provided leading to patient harm and cases when it was not entirely clear, but significant patient harm occurred. Near-misses are cases when an error in medical care occurred, but it was discovered prior to administration to the patient or there was an unrecognized or minimal effect on the patient. The system continues to collect increasing number of reports each year and is functioning well. Information from the medical information reporting system provides a report to the hospital with action items going forward to help improve patient safety.
The next session is Expectations For Anesthesia Professionals Focusing on Patient Safety. The first speaker is Michiko Taniguchi to talk about “Regional Healthcare Strategies in Japan.” There are important considerations for delivering healthcare in Japan given the decrease in the working population. Securing human resources will become an increasing issue after 2025. There will also be changes in medical demand with increasing number of hospitalized patients, declining outpatients, increasing homebound patients along with increased need for emergency transport and acute care. In order to secure doctors, there is work being done to provide incentives in the doctor training process, to create a career development program, and to reform the way doctors work. This last step, reforming how doctors work includes an acknowledgement that it is important to create an environment that is supportive for doctors who are providing local medical care with shorter working hours and additional support to balance work and family life. Options for working to meet the demand for medical care in remote areas include telemedicine and online medical consultations, mobile medical visits, and dispatch of doctors to areas in need.
From the big picture of healthcare delivery, we are going to focus our next discussion on anesthesia patient safety with the speaker, Michiaki Yamakage, and the talk, “Directions and Strategies to Improve Patient Safety in Japan: The Japanese Society of Anesthesiologists (JSA) Perspective.” Did you know that the JSA was established in 1954 and will be celebrating the 70th Anniversary this year. In that time, the JSA has done a lot of work to develop the field of anesthesia in Japan with certified anesthesiologists and the creation of specialty societies such as the Japan Society for Geriatric anesthesia. The safety committee has developed important guidelines to help improve patient safety and the education committee has set guidelines for trainees and knowledge and skills for certified anesthesiologists. Stay tuned for continued work by the JSA to improve anesthesia patient safety going forward.
Since this is an international conference, we need to look at patient safety from a global perspective. Adrian Gelb offers his insights in this area. Did you know that more than 5 billion people lack access to safe, affordable surgical, anesthesia, and analgesia care? Here are some additional patient safety concerns:
85% of countries have limited access to opioids for the treatment of acute and chronic pain
Maternal mortality with 20% related to anesthesia with either no anesthesia professional available or poorly trained/poor resourced anesthesia professionals leading to patient death
If surgical care were a disease, then it would be the third leading cause of death.
Gelb reminds us that there are significant challenges to providing safe anesthesia and surgery throughout the world. It is a basic human right that everyone is entitled to safe anesthesia-surgery care. This is our social responsibility that we need to think about as we provide service so that we can do what’s best for patients wherever you practice in the world.
So, how do we tackle the problem of perioperative mortality?
The first challenge is access to care. We need to do a better job delivering the message to politicians and the public about what we do and why patient safety is so important. From the patient’s perspective, the first challenge is getting to a hospital safely within 2 hours. The next issue is workforce as well as adequate volume of surgical care since there is a direct relationship between the volume of surgical care and the quality of that care. There also needs to be financial safety when it comes to receiving care and being able to pay for the services.
When thinking about the global perioperative mortality rate, this is difficult to determine and important factors include failure to access care, failure to provide quality care, and failure to rescue, that is managing postoperative complications. Standards are critical to improve patient safety around the world including professional aspects, facilities and equipment, medications and IV fluids, monitoring, and conduct of anesthesia. Medication safety is a problem around the world with even higher rates in low and middle-income countries. The World Federation of Societies of Anaesthesiologists is working on global recommendations for medication safety which depend on the available resources. For example, for medication labeling it is recommended to label in any way possible in low-income countries and to use a barcode scanner in high-income countries.
Do you want to help improve global patient safety? Check out the education opportunities through the WFSA which includes clinical fellowships, CME opportunities with tutorials and educational trips for regional training. I will include a link in the show notes for more information.
For our next perspective we are going to hear from Norihiko Ikeda and the talk, “New collaboration between surgeons and anesthesiologists for safe surgery: surgeon’s perspective.”
The relationship between surgeons and anesthesiologists is critical. Surgeons must communicate with anesthesiologists to help keep patients safe especially in the following situations:
· Changes in the surgical procedure due to new studies, guidelines, or recommendations from the surgical literature.
· High-risk cases based on patient comorbidities or the surgical procedure
· Risks of new treatment including preoperative treatment that may impact patients during the perioperative period such as immunotherapy.
This communication helps to improve the surgeon-anesthesiologist relationship and keep patients safe during surgery and anesthesia care.
Ronald Harter is the next speaker to discuss, “ASA's Efforts to Promote Clinician Well-Being and its Impact on Patient Safety.” First up, let’s define burnout. It is a state of high emotional exhaustion, high depersonalization, and lack of sense of personal accomplishment. The data for physician burnout in the United States is concerning. In March 2020, among US trained anesthesiologists, 59% had a high risk of burnout and 13.8% had burnout syndrome. The study was repeated two years later with increasing rates of high risk of burnout and burnout syndrome with 36% of responders reporting that they were likely to leave their job in the next two years. If this occurs, it will severely impact ability to provide anesthesia services in the US.
So, what is ASA doing for Physician Well-Being? Check out the article in the ASA Monitor by Vinson and Sinskey, “ASA Committee on Physician Well-Being: Who We Are, Why We Care, and How We Can Help.” I will include the citation in the show notes as well. Some considerations for improved physician well-being include recognition of the problem, support systems at home and at work, focus on quality and safety of what we go, improve opportunities for personal accomplishment during non-clinical time which may include engagement in administration, educational, and/or research opportunities that create a reason to remain in anesthesiology.
Our final speaker for this session and this podcast episode is Ikuro Yamaguchi to discuss “Our ideal anesthesia professional: From a patients’ perspective.” This talk introduces the Consumer Organization for Medicine and Law Activities to help patients be more independent and to take part in joint decision making. Providing safe patient care requires collaboration without confrontation.
There are 4 major activities by this organization each year:
· Creation of booklets – “10 Main Points When Seeing a Doctor and 10 Main Points of body and life for children
· Courses for training healthcare service volunteers
· Courses to foster non-expert members of healthcare committees
· Simulated patients hospital visits
Emerging from this work with patients is that the role of the anesthesiologist is poorly understood. Often, patients focus on the surgeon. It is important to communicate the anesthesiologist’s roles and make them more visual. Here are some ideas:
The importance of Preoperative Medical examination
Manage general condition of patients during surgery
Role in direction and supervising the entire team and the overall health of the patient
Anesthesiologist are involved in crisis management
When patients don’t understand, it may be due to lack of basic knowledge of terminology, treatment effects, and other background knowledge. After a procedure, patients may be unsatisfied with the outcome due to a lack of understanding.
It is important to ask patients if they have any additional questions. Don’t just ask, “Do you understand?” It is important to proactively check level of understanding in a non-confrontational manner to help develop a relationship built on trust and collaboration.
The patient-physician relationship of the future should strive to move away from one-sided explanations and informed consent to include sharing information and discussing and making decisions together.
What a great session to help wrap up this episode. There are still more excellent talks from the conference and more ways to keep your patients safe, no matter where you are in the world. Mark your calendars for next week as we continue this series. Plus, we have a special guest to help open the show.
If you have any questions or comments from today’s show, please email us at podcast@apsf.org. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.
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Until next time, stay vigilant so that no one shall be harmed by anesthesia care.
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