Updates to the APSF Patient Safety Priorities

When it was founded in 1985, the Anesthesia Patient Safety Foundation (APSF) was first patient safety organization in the U.S. and ignited the modern patient safety movement. The APSF’s core goal is to ensure “that no patient shall be harmed by anesthesia” [1]. To realize this, the APSF worked closely with the American Society of Anesthesiologists and several other prominent organizations to support research and education about patient safety. Some of the patient safety issues that the APSF focuses on include postoperative cognitive dysfunction, OR crisis management, and morbidity risks following long-term general anesthesia. One of the APSF’s early successes involved raising awareness of the danger of decreased cerebral perfusion pressure when patients were placed in in the “beach-chair” position. A 2004 report on perioperative inflammation and long-term mortality was also highly influential [2]. A list of Patient Safety Priorities offers insight into the APSF’s current interests and future investments. In 2018, the APSF board ranked its top patient safety priorities based on the most recent literature, expert advice, and suggestions submitted to the APSF Newsletter. At that point, the APSF agreed to revisit the list on an annual basis. To create the 2021 list, the APSF board narrowed down a short-list of 16 priorities to just ten. In addition to publishing these priorities, the APSF highlighted the efforts it has undertaken to meet these goals [3].

The APSF’s top priority in 2021 is a culture of safety, inclusion, and diversity. This expands on the APSF’s original mission — to ensure patient safety — and serves as an acknowledgement that biases and discrimination play a role in a patient’s safety. This priority has featured near the top of the list for the past several years and includes several components, including supporting a learning (instead of punishing) work culture, an acknowledgement of anesthesia’s high-risk nature, and a dedication to teamwork. The second priority — teamwork, collegial communication, and multidisciplinary collaboration — is similar in its focus. In a July memo in the ASA Monitor, APSF board member May Pian-Smith suggested that the anesthesiologist and/or surgeon leading a procedure should invite relational coordination before and during surgery. This can be as simple as acknowledging the difficulty of a case and inviting the rest of the surgical team to speak up during surgery [4].

While workplace culture-related priorities have ranked high in past years, it is notable that these two priorities now lead the list. Last year, the APSF’s top safety priority was preventing clinical deterioration [5]. While that priority still ranks high on the 2021 list, the new emphasis on workplace culture acknowledges that patient safety relies on a positive culture in the OR.

Other notable additions in the 2021 list include the prevention and mitigation of opioid-related harm in surgical patients and emerging infectious diseases (including but not limited to COVID-19), including patient management, guideline development, equipment modification, and determination of operative risk. Missing from previous years, however, is an emphasis on cost-effective protocols, burnout, and distractions in procedural areas. The APSF notes that some of these issues will be integrated into the 2021 patient safety priorities, while others weren’t seen as a high enough priority to make it onto the list this year.

Overall, the APSF’s 2021 Patient Safety Priorities emphasize workplace culture as a critical component of patient safety. The APSF has also examined events outside of anesthesia, including the COVID-19 pandemic and the opioid epidemic. These have led to new APSF priorities focused on mitigating these risks.


[1] Eichhorn, John H. “The Anesthesia Patient Safety Foundation at 25.” Anesthesia & Analgesia, vol. 114, no. 4, 2012, pp. 791–800., doi:10.1213/ane.0b013e3182427536

[2] Meiler, Steffen, et al. “Can We Alter Long-Term Outcome? The Role of Inflammation and Immunity in the Perioperative Period (Part II).” APSF Newsletter, vol. 19, no. 1, 2004, pp. 3–5., dev2.apsf.org/wp-content/uploads/newsletters/2004/spring/pdf/APSF200403.pdf. 

[3] Greenberg, Steven. “The APSF Revisits Its Top 10 Patient Safety Priorities.” APSF Newsletter, vol. 36, no. 2, June 2021, www.apsf.org/article/the-apsf-revisits-its-top-10-patient-safety-priorities/. 

[4] Pian-Smith, May C. M. “Fostering Trusting Relationships: A Patient Safety and Clinician Wellness Strategy.” ASA Monitor, vol. 85, no. 7, 2021, pp. 42–43., doi:10.1097/01.asm.0000758400.29326.26

[5] Greenberg, Steven, and Mark Warner. “APSF: A Pioneer for Patient Safety.” ASA Monitor, vol. 84, no. 11, 2020, pp. 34–35., doi:10.1097/01.asm.0000722160.34312.2a.

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