Anesthesia Risk Alert Program: A Proactive Safety Initiative

Analyzing adverse events data collected over a three-year period on all anesthetic cases, North American Partners in Anesthesia (NAPA), a nationwide anesthesia practice, found a correlation between certain high-risk clinical factors and a number of critical events. Seeking to reduce the incidence of critical adverse events associated with these high-risk factors, the quality team of the NAPA Anesthesia Patient Safety Institute (NAPSI) developed the Anesthesia Risk Alert (ARA) program, which guides clinicians in proactively applying targeted risk mitigation interventions in five specific clinical scenarios. NAPSI is NAPA's Patient Safety Organization (PSO).

ARA promotes a proactive (Safety II) approach to patient safety. The protocol incorporates innovative collaboration techniques to improve clinical decision-making, along with recommendations by professional medical societies. ARA risk mitigation strategies also adapt decision tools from other industries, such as red team/blue team methodology. Following implementation training to approximately 6,000 NAPA clinicians, ongoing compliance is tracked for the program's two components: screening patients for the five high-risk clinical scenarios and performing the associated mitigation strategy when one or more risk factor is identified.

Since launching the ARA program in 2019, clinician compliance consistently exceeds 95%. Simultaneously, available data indicate that the incidence of selected adverse events has decreased.

ARA, developed as a process improvement initiative to reduce patient harm in several vulnerable perioperative patient populations, demonstrates how proactive safety strategies can improve clinical outcomes and create better perioperative cultures. At various sites, NAPA anesthesia clinicians reported that ARA's collaboration strategies were transformative behaviors that extended beyond the operating room. Other health care providers may customize the lessons learned from ARA with a Safety II approach.