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Focused Review: A Look into Anesthesia

Anesthesiologists play a vital role in a patient’s surgical experience. They are charged with ensuring medical readiness for surgery, providing medical management and anesthetic care, and evaluating a patient’s readiness for discharge/or transfer to a medical floor or intensive care unit.

In the latest Risk Management and Patient Safety Focused Review, A Look into Anesthesia, CAP identified 637 medical negligence claims against CAP anesthesiologists over a 10-year period dating from January 1, 2006 through December 31, 2017, and analyzed the top areas of liability and risk management concern among 51 of those claims that incurred an indemnity payment greater than $200,000, which included:

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Failure of pre-operative anesthesia assessment/evaluation

Failure to recognize and treat 

Failure to monitor

Delay or failure in treatment with regards to intubation, or re-intubation

Lack of communication between care providers

Failure of informed consent

Complications related to a retained foreign body (epidural catheter tip)

From the 1950s through the 1970s, anesthesiology was considered one of the riskiest specialties. Anesthesiology claims had one of the highest paid-to-closed percentages and represented a disproportionate amount of large-payout indemnities.1 As a result, in 1985 the American Society of Anesthesiologists (ASA) created an important patient safety initiative, the Anesthesia Closed Claims Project. The closed claims data project produced numerous new standards, practice guides, and enhancements to clinical education using simulations.

These changes have led to a decrease in anesthesia indemnity payments. Today, anesthesiologists have a lower claims frequency largely due to advances in patient monitoring, improved anesthetic agents, and new drug therapies.2

A Look into Anesthesia features three case studies that exemplify the patient outcomes that occur when there is not a thorough pre-anesthetic patient assessment and includes risk control strategies focusing on areas of patient consent, documentation, patient history, and unanticipated outcomes.

The Risk Management and Patient Safety Focused Review: A Look into Anesthesia can be downloaded at

CAP’s goal in publishing this study is to share the real experiences of member anesthesiologists with all CAP physicians — regardless of their specialty or location of practice — with the hope of improving healthcare and patient safety, as well as reducing medical liability risk.

CAP’s Risk Management and Patient Safety staff is available to discuss ways to implement effective risk strategies and assist with systems process improvement challenges. Questions or comments about the focused review may be sent to   

1Stoelting, Robert, M.D. Retrieved from the Anesthesia Patient Safety Foundation at
on February 22, 2020.

2Inside Medical Liability Magazine; Second Quarter 2018. MPL. Association Copyright 2018.