Intended for healthcare professionals

Education And Debate

Anaesthesiology as a model for patient safety in health care

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:785
  1. David M Gaba (, director
  1. Patient Safety Center of Inquiry, 112PSCI, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA

    Although anaesthesiologists make up only about 5% of physicians in the United States, anaesthesiology is acknowledged as the leading medical specialty in addressing issues of patient safety.1 Why is this so?

    Firstly, as anaesthesia care became more complex and technological and expanded to include intensive care it attracted a higher calibre of staff. Clinicians working in anaesthesiology tend to be risk averse and interested in patient safety because anaesthesia can be dangerous but has no therapeutic benefit of its own. Anaesthesiology also attracted individuals with backgrounds in engineering to work either as clinicians or biomedical engineers involved in operating room activities. They and others found models for safety in anaesthesia in other hazardous technological pursuits, including aviation. 2 3

    Secondly, in the 1970s and ‘80s the cost of malpractice insurance for anaesthesiologists in the United States soared and was at risk of becoming unavailable. The malpractice crisis galvanised the profession at all levels, including grass roots clinicians, to address seriously issues of patient safety. Thirdly, and perhaps most crucially, strong leaders emerged who were willing to admit that patient safety was imperfect and that, like any other medical problem, patient safety could be studied and interventions planned to achieve better outcomes.

    Summary points

    Anaesthesiology is acknowledged as the leading medical specialty in addressing patient safety

    Anaesthesia is safer than ever owing to many different types of solutions to safety problems

    Solution strategies have included incorporating new technologies, standards, and guidelines, and addressing problems relating to human factors and systems issues

    The multidisciplinary Anesthesia Safety Foundation was a key vehicle for promoting patient safety

    A crucial step was institutionalising patient safety as a topic of professional concern

    Although anaesthesiology has made important strides in improving patient safety, there is still a long way to go

    Accomplishments in patient safety in anaesthesiology

    Anaesthesia: safer than ever

    It is widely believed that anaesthesia is …

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