Perspectives on Anesthesia and Perioperative Patient Safety: Past, Present, and Future

Area of Science:

• Healthcare Management
• Patient Safety Science
• Systems Engineering

Background:

• Patient safety science has evolved over 70 years through distinct organizational frameworks.
• Early frameworks (Safety-0, Safety-1) focused on error reduction and system failures.
• Later frameworks (Safety-2, Safety-3) emphasize adaptability and integrated system design.

Purpose of the Study:

• To review the evolution of patient safety frameworks.
• To highlight the principles and applications of Safety-3.
• To propose Safety-3 as a model for improving anesthesia and perioperative care.

Main Methods:

• Historical review of patient safety frameworks (Safety-0 to Safety-3).
• Analysis of the core principles and methodologies of each framework.
• Examination of Safety-3's application in aviation and its potential for healthcare.

Main Results:

• Safety-0 blamed individuals; Safety-1 focused on system failures.
• Safety-2 introduced resilience engineering and adaptability.
• Safety-3 integrates system design, human factors, and operational control, offering a comprehensive approach.

Conclusions:

• The evolution from blaming individuals to sophisticated system design shows progress in patient safety.
• Safety-3, with its emphasis on human factors and system controls, represents the most advanced framework.
• Adopting Safety-3 principles can significantly enhance patient safety in anesthesia and perioperative settings.