Brain Health Initiative: A New ASA Patient Safety Initiative
Brain Health Initiative: A New ASA Patient Safety Initiative
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脑健康计划：一项新的 ASA 患者安全计划
DOI：
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
L. Fleisher
中科院分区：
文献类型：
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作者：
L. Fleisher
作为第一个关注病人安全问题的专业，早于1999年医学研究所（现在的国家医学科学院）发布的报告《犯错是人的》。在世纪的后半叶，我们的领导人认识到，我们通过自己的行为将患者置于风险之中，而发展包括检查清单在内的护理系统可以降低风险并获得更好的结果。事实上，医学研究所的报告和其他人声称，麻醉相关的发病率和死亡率改善到麻醉是安全的。虽然我们的专业确实在努力提高患者安全方面领先于其他专业，但许多其他专业已经重新调整了工作重点，包括使用更广泛的定义来减少并发症。重要的是，手术患者的发病率和死亡率仍然很高，过去几十年的工作已经清楚地表明，麻醉师采取的措施可以改善围手术期结局，特别是当我们扩大麻醉相关并发症的定义以包括所有手术结局的联合责任时。作为将我们的注意力集中在我们的领导可以改善患者结局的领域的一种手段，阿萨总裁丹尼尔科尔，医学博士，提出了一个新的病人安全倡议-脑健康倡议。作为麻醉医师，我们非常清楚患者及其家属的重要关注，因为他们或他们的父母或祖父母在手术后立即或长时间内，从神经学或心理学的角度来看，经常是“不一样的”。这些变化可以像术后谵妄一样急性，也可以是更微妙的认知变化。正如Berger和Eckenhoff博士在随附文章中所述，术后认知功能障碍的诊断和定义正在由多学科小组进行评估，并可能在不久的将来进行更改或澄清。重要的是，手术后即刻和长期神经精神变化的原因可能是多因素的，包括麻醉、手术或简单的自然病程。然而，正如Deiner博士和Humeidan博士在随附的文章中讨论的那样，显然有些药物不应该给老年人服用，因为它们与谵妄有关。对其中一些违规行为的管理
being the specialty that first focused on the issue of patient safety, years before the Institute of Medicine (now the National Academy of Medicine) report To Err Is Human was issued in 1999. In the second half of the 20th century, our leaders recognized that we placed our patients at risk through our own actions, and that developing systems of care, including checklists, could lead to lower risk and better outcome. In fact, the Institute of Medicine report and others claimed that anesthetic-related morbidity and mortality improved to the point that anesthesia was safe. While our specialty did lead other specialties in efforts to improve patient safety, many other specialties have refocused their efforts, including on reducing complications using wider definitions for areas in which they are accountable. Importantly, surgical patients continued to have high rates of morbidity and mortality, and work over the past several decades has made it clear that actions taken by anesthesiologists can improve perioperative outcomes, particularly when we expand the definition of anesthesia-related complications to include joint accountability for all surgical outcomes. As a means of focusing our attention on an area in which our leadership can result in improved patient outcome, ASA President Daniel Cole, M.D., proposed a new patient safety initiative – the Brain Health Initiative. As physician anesthesiologists, we are well aware of the important concerns of patients and their families in that they or their parents or grandparents are frequently “not the same” from a neurologic or psychologic standpoint, either immediately or for prolonged periods after surgery. These changes can be as acute as postoperative delirium, to more subtle cognitive changes. As outlined in the accompanying article by Drs. Berger and Eckenhoff, the diagnosis and definition of postoperative cognitive dysfunction are being evaluated by a multidisciplinary group and will likely be changed or clarified in the near future. Importantly, the causes of neuropsychiatric changes in the immediate and longterm period after surgery may be multi-factorial and include anesthesia, surgery or simply the natural course of disease. However, there are clearly drugs that should not be given to the elderly because of their association with delirium, as discussed in the accompanying article by Dr. Deiner and Dr. Humeidan. Administration of some of these offending