The Institute of Medicine (now the National Academy of Medicine) defined quality patient care as care that is safe, timely, effective, efficient, equitable, and patient-centered. These discrete elements have historically been conflated by health care organizations. The drawback to this approach is that each of these elements often requires different expertise and skillsets. The requirements of collecting data, reporting, ensuring competencies, and interacting with regulatory agencies are time- and effort-consuming. For a large-sized anesthesiology department, these tasks are likely to be overwhelming for a single individual. Although quality and patient safety are often used interchangeably and are sometimes interdependent, there are important differences between the two. Quality health care focuses on doing the right thing for the right patient, while patient safety focuses on the prevention of error and adverse events. Thus, the leadership roles of each of these domains are best served by different individuals, highlighting a clear need for a dedicated patient safety officer in each department and institution.

The patient safety officer’s duties include not only the response to adverse events, but also prevention and mitigation of harm when adverse events occur. Teaching is a key component of the role, and it is especially important for the patient safety officer of an academic program. Another important responsibility lies outside of the department, as a leader of the safety program at the hospital and health system level. For the individual in the role of managing safety in a complex environment, adequate training and qualifications are essential. Ideally, this would include a recognized degree or extensive experience, several years of clinical practice before assuming the role, and, in recognition of the continuous advancement of the field, continued education in the safety sciences. Obtaining the Certified Professional in Patient Safety (CPPS) credential may be desirable for patient safety officers. The CPPS credential establishes standards and a proficiency level for patient safety practitioners, and maintenance of the credential requires demonstration of continuous learning and practice in the field.

Anesthesiologists have engaged in patient safety work since the founding of the specialty, and anesthesia-related harm has continued to decrease despite an aging population undergoing more complex surgical procedures. To maintain this degree of safety, education is important for both trainees and faculty. The Accreditation Council for Graduate Medical Education (ACGME) specifies requirements for graduate medical education in anesthesiology. These requirements explicitly mention that faculty members must have varying interests, capabilities, backgrounds, and specialized expertise in diverse practices of anesthesiology. They also state that anesthesiology faculty must pursue “development designed to enhance their skills at least annually in quality improvement, eliminating health inequities, and patient safety.” The anesthesiology department patient safety officer is the ideal person to ensure that these requirements for training are met and specific competencies for those in training have been suggested. Topics that should be covered include systems thinking as it applies to adverse event review and the development of safety solutions, an introduction to human factors techniques, and the development of nontechnical skills, including leading in a crisis and the coordination of care across a multidisciplinary team.

Figure: Roles of the Anesthesia Patient Safety Officer.

Figure: Roles of the Anesthesia Patient Safety Officer.

Patient safety research flourished following the publication of the Institute of Medicine report To Err Is Human in 1999. Safety should be regarded as a science, with patient safety being one domain within the larger field of safety that includes other high-risk industries. Without training in safety science, a more thorough understanding of how and why safety interventions work is replaced with quick fixes. The result is that adverse events repeat, safety data collection is suboptimal, and implementation of practices designed to reduce harm is haphazard. Academic faculty with training and experience in patient safety should be considered analogous to those with subspecialty training. They promote core patient safety principles, provide colleagues with a sound body of knowledge relevant to future practice, and lead and mentor research in patient safety.

The activities of an anesthesiology patient safety officer likely align directly with hospital-level efforts in safety. Hospital performance metrics increasingly focus on perioperative outcomes as defined by national measures of hospital safety and quality. Agency for Healthcare Research and Quality patient safety indicators – such as postoperative respiratory failure, iatrogenic pneumothorax, surgical site infections, or postoperative acute kidney injury requiring dialysis – are measures that may significantly impact national hospital rankings and safety performance. In many situations, hospital patient safety indicator rates may be linked to specific perioperative events and practices, which could necessitate collaboration between the anesthesiology patient safety officer and hospital leaders to develop systems and process improvement efforts.

While the specialty of anesthesiology has been thought of as a bridge between medical and surgical specialties, it is also the first medical field to recognize and champion patient safety as a priority. Anesthesiology patient safety officers may be called upon to serve on hospital committees to review emergency airway/resuscitation activations, trauma deaths, surgery outcomes, or peer review/credentialing. In each of these hospital-level committees, anesthesiology patient safety officers bring the perspective of personally having navigated complex medical decision-making in high-acuity situations in every hospital setting. They may be relied upon by hospital leadership to identify and standardize best practices for sedation administered by nonanesthesiologists, adapting airway management protocols for clinical situations and providing event review expertise for multidisciplinary issues spanning periprocedural areas, critical care, nursing, and pharmacy.

Literature concerning the return on investment (ROI) of the patient safety officer role is still emerging. Financial support for the role, the cost of interventions, anticipated lifespan of the interventions, and the consideration of opportunity cost (loss of potential gain from alternatives when finances are invested in patient safety instead) all need to be considered. A recent article has shown a link between evidence-based practices and improved patient outcomes and health care system ROI; 94% showed a positive ROI and none showed a negative ROI. The Centers for Medicare & Medicaid Services (CMS) and private insurers use quality metrics to determine reimbursements for hospitals and other health care providers. CMS uses their Value-Based Purchasing Program (VBP) and Inpatient Prospective Payment System to reward providers financially for providing safe care. The Leapfrog Group also has a value-based purchasing program methodology that may be used by other insurers for pay-for-performance programs. Leapfrog measures for 2023 included use of a safe surgery checklist, rates of central line-associated blood stream infections, and rates of surgical site infections in colon surgery. By influencing departmental and institutional policies and procedures, anesthesia patient safety officers can have a significant impact on how institutions meet these and other Leapfrog measures. An increase in safe care positively affects reimbursement and will substantially contribute to the ROI of the patient safety officer role. A patient safety officer at the helm of a comprehensive patient safety program is associated with significantly reduced preventable harm, hospital mortality, and associated costs, including malpractice claims.

“While the specialty of anesthesiology has been thought of as a bridge between medical and surgical specialties, it is also the first medical field to recognize and champion patient safety as a priority.18 Anesthesiology patient safety officers may be called upon to serve on hospital committees to review emergency airway/resuscitation activations, trauma deaths, surgery outcomes, or peer review/credentialing.”

Whereas the dollar costs of the patient safety officer and the interventions implemented are often straightforward, the outcomes may not be as clear. The full ROI of a patient safety officer may not be fully quantifiable. As Mikko Hypponen states, “…rarely is anyone thanked for stopping a disaster that didn’t happen.” We will never know the extent to which harm events do not occur as a result of the work of a department patient safety officer. Other important, but less quantifiable, outcomes of the patient safety officer role include departmental and organizational reputation, patient satisfaction and loyalty, and workforce satisfaction. Workforce satisfaction and the delivery of safe, quality care are linked. An effective patient safety officer who engages the workforce in the decision-making process, encourages effective communication, and allows faculty to freely express their opinions will facilitate greater workforce satisfaction. Physician job satisfaction results in increased efficiency, job performance, and retention, which all contribute to the ROI that the patient safety officer role engenders.

An anesthesiology patient safety officer positions anesthesiology departments to demonstrate tremendous value and leadership to their health care organizations. Today’s complex health care environment requires patient safety leaders who are comfortable leading a team, working through influence to build consensus, and drawing upon both technical and scholarly expertise to drive change in their organizations. Anesthesiology patient safety officers bring experience in all of these domains, and as perioperative leaders, they are attuned to ongoing workforce issues that impact patient safety. The high-level view that anesthesiology patient safety officers have of quality, safety, patient experience, and operational care delivery make them the ideal executive leaders within health care organizations who can direct the future of quality and patient safety efforts.