Marx Lecture: Data key to improving obstetric anesthesiology outcomes

Robert D’Angelo, M.D.: ‘To improve patient safety, we need a national complication registry.’

In 1939, when Gertie Marx, M.D., the “mother of obstetric anesthesia,” practiced medicine, obstetric anesthesiology didn’t exist. She pioneered the practice. She also was an early promoter of saddle block, advocate for the use of caudal catheters and the supporter of permitting fathers in the delivery room. What were the complication rates back then? We can assume they were much higher than today. But no one was keeping track.

“We’ve come a long way since the Wild West days of the obstetric anesthesiology of 1939,” said Robert D’Angelo, M.D., Professor of Anesthesiology at Wake Forest University School of Medicine. But there’s still progress to be made.

In 2014, the Score Project, a landmark five-year study published in Anesthesiology, tracked obstetric anesthesia incidents across 30 institutions. It showed that the No. 1 obstetric anesthesia complication was high spinal and there is a chance of having a serious complication in 1 in 3,000 births.

“The findings were good, but not enough to create a detailed database,” said Dr. D’Angelo, who led the study. Similarly, big data, such as hospital discharge databases, insurance enrollment, EMRs and discharge codes, don’t capture details. “To improve patient safety, we need a national complication registry,” Dr. D’Angelo said.

Enter the Anesthesiology Incident Reporting System (AIRS), which is maintained by the Anesthesia Quality Institute. AIRS is an online reporting system that allows you to report obstetric anesthesia complications confidentially and/or anonymously.

“If you have a complication, go to the AIRS homepage and click on “Report Adverse Events & Near Misses.” “It’s easy to navigate and takes just minutes to complete,” Dr. D’Angelo said. You’ll start by:

  1. Selecting the category, “regional anesthesia”
  2. Then go to “optional data”
  3. Then select “OB”
  4. For procedural service, pick “OB/GYN”

At that point, you’ll be in the event module for obstetrics. From the drop-down menu, you can select the complication and provide details for documentation. If you report confidentially, you’ll get a case number. Otherwise, that’s it.

“We need your help,” Dr. D’Angelo said. “We can’t improve outcomes unless we get you to report details on serious complications. We need detailed information and reports on AIRS. Our goal is to improve patient safety, detect patterns and create practice advisories that can create a framework to reduce incidences.

“Patients will never know that their safer anesthesia linked back to today. But what matters is that we, as anesthesiologists, worked to be even further removed from the Wild West days of Gertie’s era.”

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