Intended for healthcare professionals

Rapid response to:

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

Rapid Response:

Differences between anaesthesia and anesthesiology

EDITOR - We agree with Dr. Gaba (BMJ 2000:320:783-8) that anaesthesia
has embraced the issues of patient safety, indeed the changes he describes
have occurred in the United Kingdom. However there are significant
differences (other than spelling) between anaesthesia in the United
Kingdom and anesthesiology in the United States.

In the United Kingdom all anaesthetics are given by medically qualified
anaesthetists who are the single largest medical specialty. Not only do
anaesthetists fulfil their traditional roles in the operating theatres and
extra theatre commitments such as obstetric and imaging units, but they
are also heavily involved in trauma and resuscitation services and
intensive care medicine (93% of sessions in intensive care medicine are
done by anaesthetists). This is in contrast to the United States where
there are a substantial number of nurse anesthetists as well as medically
qualified anesthesiologists and their involvement in intensive care
medicine is often limited.

The imperative for the change in attitude to safety in the United States
was severe medico - legal pressures. Although there are such pressures in
the United Kingdom our indemnity arrangements are not the same as the
United States and would not of themselves led to change. Nevertheless,
patient safety is a high priority for anaesthetists in the United Kingdom.

We believe this is due to the roles of the Royal College of Anaesthetists
and the Association of Anaesthetists of Great Britain and Ireland through
whom patient safety issues have long been brought to the attention of all
anaesthetists and all the hospitals where they work. For example, the
College has statutory powers in relation to training and has a
comprehensive visiting scheme which reviews and approves the ability of
consultants and their hospitals to provide an environment which meets the
College's published training programme which includes safety issues. The
Association, which has its own Safety Committee, publishes guidelines on a
regular basis and these include safety related documents such as minimum
monitoring standards, the anaesthesia team and organization of anaesthetic
departments. Both bodies are consulted by the Department of Health on all
matters relating to anaesthesia.

In 1998 Good Practice: A Guide for Departments of Anaesthesia, published
jointly between the College and the Association, was launched at a unique
meeting attended by representatives from all anaesthetic departments in
the United Kingdom. This was followed by the formation of a Joint Good
Practice Committee between the two bodies which has developed a personal
portfolio for anaesthetists, a portfolio for anaesthetic departments and
guidance on appraisal and assessment ready for implementing clinical
governance and revalidation. These documents may be found on both the
College website and the Association website

In addition the Joint Committee provides a 'rapid response' team to advise
trusts and departments over any issue concerning anaesthesia, including
patient safety, that cannot be resolved locally.
The United States does not have a National Health Service or national
organisations with the power and influence of the College and the
Association. Therefore the solution for promoting patient safety in the
United States was to set up the Anesthesia Safety Foundation. However, the
Foundation is a voluntary body and does not have access to all parts of
health care in the United States as the College and the Association do
here in the United Kingdom.

Anaesthesia in the United Kingdom as in the United States appears safer
than ever. Nevertheless, things still go wrong and may cause significant
patient harm. However, we do not think we need a separate 'Patient Safety
Foundation' in the United Kingdom. Although it is currently fashionable to
decry organisations such as Colleges and Associations in the rush to
'modernisation', our track record needs no defence, we have committed
leadership and an excellent framework for the future. However, we are not
complacent and agree that 'the price of patient safety is eternal

Leo Strunin

Royal College of Anaesthetists,
48-49 Russell Square,
London WC1B 4JY

Maldwyn Morgan

Paul Cartwright
Standards Committee
Association of Anaesthetists of Great Britain and Ireland,
9 Bedford Square,
London WC1B 3RA

Competing interests: No competing interests

28 March 2000
Leo Strunin
Maldwyn Morgan, Paul Cartwright