Dr. Elizabeth Malinzak takes us behind the scenes of a fascinating educational initiative bridging knowledge gaps in anesthesiology. As a pediatric anesthesiologist at Duke University and liaison between the Anesthesia Patient Safety Foundation and Open Anesthesia, she's spearheaded the development of over 30 patient safety and quality improvement summaries designed for today's learners.

Malinzak reflects on crucial topics like crisis resource management, fatigue mitigation, and handover protocols that weren't part of traditional training. This educational void inspired her to create accessible, concise resources that meet modern learning preferences. Gone are the days of textbook deep-dives; today's professionals need searchable, digestible content they can absorb between cases or during brief study sessions.

What makes these summaries particularly valuable is their breadth and collaborative development. Each summary is peer-reviewed and often created through mentoring relationships between experienced clinicians and trainees, creating educational value beyond the finished product.

Malinzak offers a clarifying perspective on how quality improvement relates to patient safety: "Patient safety is the goal... That's what we want to accomplish with every single patient. Quality improvement is the process... how we get to the goal." As anesthesiologists face increasingly complex cases and efficiency pressures, this distinction helps practitioners develop systematic approaches to protect vulnerable patients. Looking ahead, she envisions technologies like AI reducing administrative burdens so clinicians can focus entirely on vigilant patient care. Discover these valuable resources by visiting Open Anesthesia's website and filtering for patient safety topics – you never know which summary might teach you something new today.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/260-openanesthesia-and-the-apsf-achieving-safe-and-quality-anesthesia-care-with-education-innovation/

© 2025, The Anesthesia Patient Safety Foundation

Intrahospital transport of critically ill patients presents significant safety risks that can be mitigated through proper guidelines, checklists, and handoffs between care teams. The episode examines transport-related adverse events and complications while providing practical tools to enhance patient safety during these vulnerable transitions.

• Multiple categories of intrahospital transport adverse events including respiratory, cardiovascular, neurological and equipment-related complications
• Risk factors for transport complications including patient characteristics, transport circumstances, and team experience
• Society of Critical Care Medicine guidelines focusing on four components: communication, personnel, equipment and monitoring
• Comprehensive perioperative transport checklist covering identification, airway, breathing, circulation, neurological status and equipment
• Multi-Center Handoff Collaborative tools providing structured approaches to handoffs between care teams
• Recommendations including pre-transport risk assessment, education for all team members, and implementation of standardized checklists
• Importance of system design considerations like uncluttered hallways and team formations that optimize patient observation

The deadline for the October 2025 APSF newsletter is July 1st. Check out the guide for authors at APSF.org for more information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/259-every-move-matters-why-transport-safety-can-save-your-critical-patients/

© 2025, The Anesthesia Patient Safety Foundation

The journey between hospital departments can be the most dangerous part of a patient's perioperative experience. This eye-opening episode dives deep into the hidden risks of intra-hospital patient transport. We examine the current literature on transport safety with particular focus on the challenges faced by anesthesia professionals. The data is sobering — between 4-9% of transported patients require medical intervention due to transport-related complications. With increasing production pressure, decreased support personnel, and rising patient acuity, we ask the critical question: are we transporting patients safely?

We break down transport-related adverse events into essential categories: respiratory, cardiovascular, neurological, and equipment-related. The 2023 I-TOUCH study provides valuable insights, showing cardiac events, respiratory complications, neurologic issues, and equipment problems as the most common challenges during transport. We explore how patient factors (age, illness severity, ventilation requirements) and system factors (transport duration, communication gaps, staff experience) contribute to these risks.

Beyond patient safety, we discuss the often-overlooked physical risks to anesthesia professionals themselves, who report high rates of work-related musculoskeletal injuries from maneuvering heavy transport equipment while managing patient care. The good news? Evidence-based guidelines exist to mitigate these risks. Join us next week as we continue this crucial conversation with practical recommendations from the American College of Critical Care Medicine and the Society of Critical Care Medicine for safer perioperative patient transport.

Have you experienced challenges during patient transport? Share your experiences and learn from colleagues by emailing podcast@apsf.org or visiting apsf.org for more resources on perioperative safety.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/258-wheels-of-risk-when-patient-safety-rolls-through-hospital-corridors/

© 2025, The Anesthesia Patient Safety Foundation

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have revolutionized treatment for type 2 diabetes, heart failure, and chronic kidney disease—but they're creating new challenges for anesthesia professionals. With more patients on these medications heading to surgery, understanding their unique perioperative risks has never been more critical.

At the heart of this issue lies euglycemic ketoacidosis—a potentially life-threatening complication that's particularly insidious because it lacks the classic hyperglycemia that would normally trigger suspicion. We dive deep into the latest evidence, revealing that patients on SGLT2 inhibitors have an increased risk of developing postoperative ketoacidosis compared to those not taking these medications, with significantly worse outcomes when complications occur.

We present a practical algorithm for risk stratification, considering factors like procedure duration, anesthesia type, diabetes control, and comorbidities. You'll learn which patients should hold their medication, which can proceed with caution, and what monitoring strategies to implement when patients haven't properly discontinued their medication before surgery. This guidance is especially valuable for emergency cases where postponement isn't an option.

Whether you're developing institutional protocols or making decisions for individual patients, this episode equips you with the knowledge to navigate the complexities of SGLT2 inhibitor management in the perioperative period. Subscribe to stay informed about the latest in anesthesia patient safety and join our mission to ensure no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/257-sweet-trouble-perioperative-management-of-sglt2-inhibitors/

© 2025, The Anesthesia Patient Safety Foundation

This is a Fresh Flow Podcast Takeover Show. The need for strong leadership in anesthesiology has never been more crucial. Join us as we discuss structured mentorship programs and the skills required to develop effective leaders in anesthesia. Dr. Mesrobian shares insights into cultivating future leaders and the importance of training in operational management.

Here are some of the highlights:

• Operating room management and operational efficiency directly impact physician wellness by reducing unpredictability
• Balancing the demand side of anesthesia services represents a crucial opportunity for the specialty
• Scale allows large organizations to develop standardized programs in patient experience and safety
• Anesthesiologists possess unique abilities to manage complex operations that no one else in the hospital can match
• Current residency programs need to incorporate leadership and operational training
• Developing future leaders requires identifying those with leadership attributes and providing structured mentorship
• The lines between academic and private practices are blurring as all face similar challenges
• Hospital partners increasingly expect "skin in the game" with performance metrics tied to financial support
• Standardization of processes offers opportunities to improve efficiency while maintaining safety

To learn more about improving perioperative processes, check out the Fresh Flow podcast, a collaboration between University of Alabama Medicine and the Association of Anesthesia Clinical Directors.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/256-skin-in-the-game-a-fresh-flow-podcast-takeover/

© 2025, The Anesthesia Patient Safety Foundation

Fear of the unknown is one of the most significant sources of anxiety for surgical patients. What exactly happens when we're "put under"? Could we wake up during surgery? What side effects should we expect? Our latest episode tackles these common concerns by exploring the APSF's Patient Guide to Anesthesia and Surgery.

We walk through a simulated pre-surgical consultation, addressing the questions that weigh heaviest on patients' minds. We also explore factors affecting wake-up time, from medication choices to individual metabolism, and why some patients experience delayed emergence.

The episode provides a comprehensive overview of potential side effects, from common temporary issues like dry mouth and nausea to rare serious complications. We discuss allergic reactions to anesthetics, distinguishing between true allergies, pseudo-allergic responses, and typical side effects. Throughout the conversation, we emphasize how patients can reduce their risks through open communication with their healthcare team, following pre-surgery instructions, and disclosing their complete medical history.

Knowledge is power, especially when facing surgery. By understanding what happens during anesthesia and how medical professionals ensure safety throughout the process, patients can approach their procedures with greater confidence and participate more actively in their care. Share this episode with anyone preparing for surgery who deserves clear, factual information about what to expect during their anesthetic journey.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/255-what-you-need-to-know-before-going-under/

© 2025, The Anesthesia Patient Safety Foundation

Fear of the unknown can make surgery and anesthesia unnecessarily stressful. Approximately 90% of patients experience some degree of anxiety about "going under" before their procedure – worrying about pain, waking during surgery, or post-operative grogginess. But what if patients had reliable answers to their most pressing questions?

The Anesthesia Patient Safety Foundation has developed a groundbreaking resource to address this need. In this episode, we introduce the Patient Guide to Anesthesia and Surgery – a comprehensive tool designed to demystify the perioperative experience. Salvador Gullo Neto, lead of the APSF Patient Engagement Workgroup, explains why patient involvement matters: "If the patient is the primary stakeholder in their own safety, why are they left out of these conversations?"

We explore the guide's three detailed sections – Anesthesia FAQ, Surgery FAQ, and Pain Management FAQ – covering everything from different types of anesthesia to essential questions patients should ask their clinicians before surgery. The guide addresses common concerns like the risks of anesthesia, what to expect during recovery, and options for managing post-operative pain. For medical professionals, it serves as a valuable reference during patient consultations.

Healthcare has evolved from being done "for" patients to being done "with" patients as active participants. This shift represents the future of medical care – a collaborative approach where informed patients and dedicated healthcare professionals work together to achieve the best possible outcomes. We hope that you will check out this invaluable resource today and share it with patients, colleagues, and loved ones. Visit APSF.org or check our show notes for more information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/254-the-patients-guide-to-anesthesia-and-surgery/

© 2025, The Anesthesia Patient Safety Foundation

The safe management of non-cardiac implantable electrical devices during surgery requires careful planning and knowledge of device-specific considerations. We continue our discussion from last week with actionable recommendations for each stage of perioperative care.

• Electrocautery poses significant risks including device reprogramming, thermal burns, and damage to neural tissue
• Turn off devices or set to safe surgery mode before using electrocautery
• Bipolar cautery is safer than monopolar; if monopolar is needed, use lowest power setting
• Place grounding pads to minimize current through the device generator
• Somatosensory evoked potentials (SSEPs) are relatively safe while motor evoked potentials (MEPs) should be avoided
• Newer devices may be MRI conditional but require specific protocols including device interrogation
• Regional anesthesia should use ultrasound guidance rather than nerve stimulation techniques
• Neuraxial anesthesia is not contraindicated for spinal cord stimulator patients but must be placed below insertion level
• ECT can be performed with device turned off and careful electrode placement
• Devices should be turned back on before emergence from anesthesia
• Postoperative evaluation should include checking for thermal injuries and neurologic changes

Thanks for joining us for our 253rd episode! Wow, 250 and counting! Go tell a friend or colleague about our show as we work toward 500 episodes. If you enjoy the Anesthesia Patient Safety Podcast, please give us a five-star rating, subscribe, and share with colleagues.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/253-when-electrocautery-meets-implanted-devices-what-every-anesthesia-professional-needs-to-know/

© 2025, The Anesthesia Patient Safety Foundation