Great credit must be given to the anesthesiology profession for its pioneering work toward reducing anesthesia errors. The development of anesthesia in surgery ranks with antibiotics and vaccines as one of the foundations of modern medicine – indeed, of modern civilization. Early in the development of anesthesiology, catastrophic medical errors were all too frequent. Anesthesia errors are often devastating because they can involve the airway and delivery of oxygen to the brain. The margin for error is small, and the time to discover and correct an error, fleeting.

In 1905, the American Society of Anesthesiologists was formed. For decades, it existed primarily as a professional association for the benefit of practitioners. In the late 1970s, however the ASA led a massive effort to reduce anesthesia errors. Using principles borrowed from the airlines industry, the anesthesia profession, led by the ASA, determined the root causes of most serious anesthesia errors. Communication breakdowns, mental lapses, and inadequate pre-examination were amongst some of the leading causes of error. Since 1986, the ASA has produced practice guidelines which are the foundation of good anesthesia practice. Checklists, clear understanding by each member of the anesthesia team, open communication as every team member’s obligation, an anesthesia plan understood by all team members, are some of the most important aspects of the ASA guidelines.

The history of patient safety reform in anesthesiology is a tribute not only to the medical profession, but to the legal profession. As acknowledged by the Institute of Medicine in its report, “To Err is Human, Building a Safer Health System, ”responding to rising malpractice premiums in the mid-1980s, anesthesiologists confronted the safety issues presented by the need for continuing vigilance during long operations punctuated by the need for rapid problem evaluation and action.” That a response to an impact of medical malpractice litigation (though this author does not accept the insurance industry’s claim that malpractice suits are the leading cause of premium increases), should give long pause to those who believe that closing the courtroom door to victims of medical negligence will improve our healthcare system. Outside accountability improves performance in institutions as diverse as police departments, government, large corporations, and the healthcare system. Whatever the initial causeof its groundbreaking work, the American Society of Anesthesiologists is a leader in the medical world and should be viewed as a model by associations of other medical specialists on how to reduce medication errors.