A brief history of the patient safety movement in Anaesthesia

Approaches to safety began slowly. It took a century for ether to fully replace chloroform and for PIN indexing to be introduced for gas cylinders. In the 1960's Holland in Australia and Harrison in South Africa initiated longitudinal anaesthesia mortality studies and showed a decline from 1:10,000 to 1:20,000 cases for fit patients. The relative safety of anaesthesia was confirmed by a large scale medical record review in 1990. In the 1980's Cooper introduced incident monitoring and Cheney started the closed claim study. Dealing with the lessons from these was improved by the development of realistic simulation for teaching and pre-compiled responses for the management of crises. These advance underpinned the worldwide introduction of pulse oximetry, anaesthesia safety standards and check lists. Systematic improvement in drugs, equipment, techniques, infrastructure, training and the status of anaesthetists has underpinned the remarkable improvements in patient safety to date and further improvements in these areas will maintain the place of anaesthesia as a role model for patient safety.