Fellowshipaffairscontinuedquality <strong>and</strong> safetyEleven HCI organisations supportedthe meeting. There was much praisefor the visiting speakers from theTRIAD consulting group who arebased in the US.Anzca <strong>Annual</strong> Scientific Meeting(Asm)Christchurch, <strong>New</strong> Zeal<strong>and</strong> – May 1-5The annual scientific meeting (ASM) <strong>of</strong>the <strong>College</strong> <strong>and</strong> Faculty took place at theChristchurch Convention <strong>and</strong> ExhibitionCentre. Associate Pr<strong>of</strong>essor Ross Kennedyconvened the conference with the theme“How meets why – clinical practice<strong>and</strong> the science behind It”. Dr RichardFrench was the Deputy Convenor <strong>and</strong>Dr Mark Waddington organised a verysuccessful scientific program. Pr<strong>of</strong>essorTed Shipton was the Faculty <strong>of</strong> PainMedicine Convenor <strong>and</strong> oversaw the FPMprogram. The conference welcomed 756full registrants, 154 Faculty registrants,92 exhibitor registrants <strong>and</strong> 49 dayregistrants. Conference Innovators was thepr<strong>of</strong>essional conference organiser (PCO).International visitors included ANZCAASM Visitor Pr<strong>of</strong>essor Talmage Eganfrom the US, FPM ASM Visitor Pr<strong>of</strong>essorJeffrey S Mogil from Canada, AustralasianVisitor <strong>and</strong> Douglas Joseph Pr<strong>of</strong>essor,Pr<strong>of</strong>essor Paul Myles from Australia,Pain Medicine Visitor’s Lecturer Pr<strong>of</strong>essorRichard W Rosenquist, US, <strong>and</strong>Organising Committee Visitor Pr<strong>of</strong>essorSteven Shafer, US. Industry supportedspeakers included Pr<strong>of</strong>essor GerardManecke <strong>and</strong> Dr Daniel Sessler whoboth were from the US.The ASM was supported by a strong HCIexhibition. Dr Sue Nicoll <strong>and</strong> Dr DebbieGoodall successfully organised thesocial program, with the highlight beingthe Gala Dinner which was held at theWestpac Arena. Robbie Deans, coach <strong>of</strong>the <strong>Australian</strong> rugby team delivered theoration at the <strong>College</strong> Ceremony.The <strong>New</strong> Fellows Conference wasthemed “Anaesthesia <strong>and</strong> adventure” <strong>and</strong>was held prior to the start <strong>of</strong> the ASM atHanmer Springs. Dr Karen Ryan was the<strong>New</strong> Fellows Convenor. The Faculty <strong>of</strong>Pain Medicine Refresher Course Day washeld on April 30 <strong>and</strong> themed “Creativepain management: One goal, multipleapproaches”.Named LecturesEllis Gillespie LectureANZCA ASM Visitor: Pr<strong>of</strong>essor TalmageEgan (US)“Pharmacodynamic interactions:hypnotics <strong>and</strong> opioids”.Michael Cousins LectureFPM ASM Visitor: Pr<strong>of</strong>essorJeffrey S Mogil (Canada)“What’s wrong with animal models<strong>of</strong> pain?”Mary Burnell LectureFPM ASM Visitor: Pr<strong>of</strong>essor Michael(Monty) Mythen (UK)“Why is it easier to get doctors to thetop <strong>of</strong> Mount Everest than it is to changetheir clinical practice?”Australasian Visitors LectureAustralasian Visitor <strong>and</strong> Douglas JosephPr<strong>of</strong>essor: Pr<strong>of</strong>essor Paul Myles (Aus)“Stochasticity in clinical medicine”Pain Medicine Visitor’s LecturePr<strong>of</strong>essor Richard W Rosenquist (US)“Perineural catheter techniquesfor postoperative pain managementat home”The ASM Committee LecturePr<strong>of</strong>essor Steven Shafer (US)“Unsolved mysteries <strong>of</strong> anaesthesia”Prize Winners – <strong>2010</strong>Gilbert Brown Prize:Dr Forbes McGain“Financial <strong>and</strong> environmentalcosts <strong>of</strong> drug trays”Formal Project Prize:Dr Peter John Carlin“Midwife management <strong>of</strong> epiduralanalgesia in 2nd stage labour – a survey”Renton Prize:Dr Alex<strong>and</strong>er Smirk, April 2009Dr Queenie Hoi Ying Tung,September 2009Cecil Gray Prize:Dr James Jarman, May 2009Dr Louise Ellard, October 2009WorkforceAt the end <strong>of</strong> <strong>2010</strong>, there were 4950(active <strong>and</strong> retired) Fellows <strong>of</strong> the <strong>College</strong>.Of that number, 27 per cent are female<strong>and</strong> 73 per cent are male. There were 308new Fellows admitted in <strong>2010</strong>.Geographical distribution was as follows:<strong>2010</strong> Fellows <strong>New</strong> FellowsAustralia 3861 243ACT 66 7NSW 1210 65Qld 775 51SA/NT 365 24Tas 104 6Vic 950 57WA 374 33<strong>New</strong> Zeal<strong>and</strong> 558 43Hong Kong 198 11Malaysia 50 3Singapore 71 2Other 212 6Total 4950 308The number <strong>of</strong> anaesthetists admitted toFellowship by training <strong>and</strong> examination in<strong>2010</strong> was 231. There were also 76 Fellowsapproved via the international medicalgraduate specialist (IMGS) pathway.There was one new Fellow approvedvia the election to fellowship pathway.The purpose <strong>of</strong> the Quality <strong>and</strong> Safety Committee is: “To assist Councilin actively advancing the mission <strong>of</strong> ANZCA to serve the communityby fostering safety <strong>and</strong> quality in patient care in anaesthesia, intensivecare <strong>and</strong> pain medicine”.Highlights:• The committee reviewed <strong>and</strong>contributed to 10 governmentsubmissions to various organisationsincluding the <strong>Australian</strong> Commissionfor Quality <strong>and</strong> Safety in Healthcare;National Health <strong>and</strong> Medical ResearchCouncil <strong>and</strong> <strong>Australian</strong> Council onHealthcare St<strong>and</strong>ards.• Dr Peter Roessler joined the committeeas the Director <strong>of</strong> Pr<strong>of</strong>essional Affairs.• Twenty quality <strong>and</strong> safety articles werepublished in the ANZCA Bulletin <strong>and</strong>16 articles in the ANZCA e-<strong>New</strong>sletter.• The Special Committee InvestigatingDeaths Under Anaesthesia (SCIDUA)celebrated its 50th anniversary.• The <strong>Australian</strong> <strong>and</strong> <strong>New</strong> Zeal<strong>and</strong>Tripartite Anaesthetic Data Committee(ANZTADC) formed an AnalysisSubcommittee.• Each national <strong>and</strong> state committee<strong>of</strong> ANZCA has appointed a Quality<strong>and</strong> Safety Officer.Quality <strong>and</strong> Safety information atthe <strong>Annual</strong> Scientific Meeting(ASM), ChristchurchTwo sessions were particularly relevantto quality <strong>and</strong> safety: “Why Bad ThingsHappen to Good People”, <strong>and</strong> a “Quality<strong>of</strong> Recovery” symposium.External submissions, reviews<strong>and</strong> projectsThroughout <strong>2010</strong>, the committeereviewed <strong>and</strong> contributed to 10submissions. In addition, volunteerswere found to represent the <strong>College</strong> ona variety <strong>of</strong> working groups, projects,reviews <strong>of</strong> external guidelines <strong>and</strong> inseveral workshops.Work undertaken by the six Quality<strong>and</strong> Safety portfoliosEvidence-based medicine portfolio(Associate Pr<strong>of</strong>essor David Scott <strong>and</strong>Pr<strong>of</strong>essor Alan Merry)Dr Peter Roessler joined the Quality <strong>and</strong>Safety Committee in <strong>2010</strong> as the Director<strong>of</strong> Pr<strong>of</strong>essional Affairs.The following documents were approvedby Council in <strong>2010</strong>. APD1 Pr<strong>of</strong>essionalDocuments <strong>and</strong> the accompanyingbackground paper. TG4 Equipmentto Manage a Difficult Airway duringAnaesthesia <strong>and</strong> the accompanyingbackground paper (presently intheir pilot phase).The following documents are underreview:• PS46 Recommendations for Training<strong>and</strong> Practice <strong>of</strong> Diagnostic PerioperativeTransoesophageal Echocardiographyin Adults• PS28 Guidelines on Infection Controlin Anaesthesia• PS10 Guidelines on the H<strong>and</strong>over <strong>of</strong>Responsibility During an Anaesthetic• PS20 Recommendations onResponsibilities <strong>of</strong> the Anaesthetist inthe Post-Anaesthesia PeriodCommunication/liaison portfolio(Dr Patricia Mackay)ANZCA BulletinTwenty articles were published in theQuality <strong>and</strong> Safety section <strong>of</strong> the ANZCABulletin <strong>and</strong> 16 articles were publishedin the ANZCA e-<strong>New</strong>sletter, includinga number <strong>of</strong> alerts, warnings <strong>and</strong>recommended reading.The items for the Bulletin are increasingwhich is gratifying. Of note are theregular <strong>report</strong>s from ANZTADC, <strong>and</strong>the current series <strong>of</strong> <strong>report</strong>s on airwayaccidents, aimed at promoting awarenessabout the problem <strong>of</strong> “Can’t IntubateCan’t Oxygenate” scenarios. It has beensuggested by Associate Pr<strong>of</strong>essor PamMacintyre that a similar exercise could beundertaken for acute pain management,an area where adverse outcomes arestill occurring in the context <strong>of</strong> failuresto observe essential safeguards in themanagement <strong>of</strong> patients.24 ANZCA <strong>Annual</strong> Report <strong>2010</strong>ANZCA <strong>Annual</strong> Report <strong>2010</strong> 25
quality <strong>and</strong> safetycontinuedEmergency Care ResearchInstitute (ECRI) <strong>report</strong>sConsideration should be given to theusefulness <strong>of</strong> the Ecri <strong>report</strong>s <strong>and</strong> also,if they are to be continued, all such<strong>report</strong>s should be published in boththe Bulletin <strong>and</strong> the E-<strong>New</strong>sletter.The communication/liaison portfolioagreed to a process for the timely review<strong>and</strong> publication <strong>of</strong> alerts from the<strong>Australian</strong> <strong>and</strong> <strong>New</strong> Zeal<strong>and</strong> TripartiteAnaesthetic Data Committee’sWebAIRS site.Clinical indicators portfolio(Dr Margie Cowling <strong>and</strong>Pr<strong>of</strong>essor Paul Myles)Dr Cowling <strong>and</strong> Pr<strong>of</strong>essor Myles havehad input into the development <strong>of</strong>the <strong>Australian</strong> Council on HealthcareSt<strong>and</strong>ards.Legal Matters portfolio(Mr Michael Gorton, Mr Bruce Corkill,QC, <strong>and</strong> Pr<strong>of</strong>essor Alan Merry)Valuable advice <strong>and</strong> commentary wasprovided to the Quality <strong>and</strong> SafetyCommittee regarding a range <strong>of</strong>legislation <strong>and</strong> draft documentation.Mortality portfolio(Dr Neville Gibbs)The Mortality Working Group Meetingwas held in Melbourne on April 16. Thismeeting is usually held annually beforeor during the ANZCA <strong>Annual</strong> ScientificMeeting (ASM). However, this year itwas more convenient for the majority<strong>of</strong> members to hold the meeting inMelbourne, prior to the April Quality <strong>and</strong>Safety meeting, as the ASM was beingheld in Christchurch, NZ. During themeeting updates were received fromall regions:• In NSW, David Pickford replacedPr<strong>of</strong>essor Ross Holl<strong>and</strong> as chairman <strong>of</strong>SCIDUA. <strong>New</strong> legislative requirementsare being introduced in NSW under thePublic Health Act to m<strong>and</strong>ate <strong>report</strong>ing<strong>of</strong> all unexpected deaths, includingdeaths during, within 24 hours <strong>of</strong>, ordue to anaesthesia. This legislationwas necessary as a result <strong>of</strong> changes tothe Coroner’s Act. SCIDUA is lobbyingto have “or sedation” addedto “anaesthesia”.• In Victoria there is a new Public Health<strong>and</strong> Wellbeing Act, which includeslegislation to support m<strong>and</strong>atorynotification <strong>of</strong> anaesthesia mortality<strong>and</strong> major morbidity to the VictorianConsultative Council on AnaestheticMortality <strong>and</strong> Morbidity (VCCAMM).VCCAMM is liaising with the CoronialOffice to improve communication<strong>and</strong> capture <strong>of</strong> all anaesthesia-relateddeaths.• In Western Australia, there will be anattempt by the Health Department toidentify all deaths within 48 hours <strong>of</strong> asurgical procedure. It is hoped that thislist can be used to cross-check againstreceived anaesthetic mortality <strong>report</strong>s.• Dr Margaret Walker indicated in awritten <strong>report</strong> that the TasmanianAnaesthetic Mortality Committee hasbeen functioning well in associationwith the Tasmanian Audit <strong>of</strong> SurgicalMortality, <strong>and</strong> will be able to providedata for the 2006-2008 Triennial Report.• In South Australia, plans to re-establishan anaesthetic mortality committee arewell advanced. The committee’s draftterms <strong>of</strong> reference were discussed. It isenvisaged that the new committee willbe functional in 2011 <strong>and</strong> will cover theNorthern Territory as before.• In <strong>New</strong> Zeal<strong>and</strong> the formation <strong>of</strong> aPeri-operative Mortality Committeeas a ministerial advisory committeehas been approved <strong>and</strong> draft terms<strong>of</strong> reference have been circulated forcomment. The committee is nowestablished, with Dr Leona Wilsonas its deputy chair.• In the ACT there are plans to establisha Mortality <strong>and</strong> Morbidity Committee,but the current model would not allowfeedback to anaesthetists or release <strong>of</strong>data. Dr Steve Brazenor is continuing tonegotiate with authorities in the ACT.• There have been no furtherdevelopments in Queensl<strong>and</strong> in relationto its Anaesthetic Mortality Committee,which remains non-functioning.SCIDUA 50th AnniversaryThe NSW Anaesthesia CME meetingon August 14 recognised the 50thAnniversary <strong>of</strong> the foundation <strong>of</strong> SCIDUA.PublicationsA paper entitled “Anaesthetic-RelatedMorbidity in Victoria: A <strong>report</strong> from1990 to 2005” was published by DrLarry McNicol <strong>and</strong> Dr Pat Mackay onbehalf <strong>of</strong> VCCAMM in the Septemberissue <strong>of</strong> Anaesthesia <strong>and</strong> Intensive Care.This <strong>report</strong> was notable because itaddressed anaesthetic morbidity aswell as mortality.An editorial in Anaesthesia <strong>and</strong> IntensiveCare, entitled “Milestones in AnaesthesiaMortality <strong>and</strong> Morbidity Reportingin Australia”, was published by DrNeville Gibbs which accompanied theAnaesthetic Related Morbidity Report.These editorials were recognised at the50th Anniversary <strong>of</strong> SCIDUA.2006-2008 Triennial ReportDuring the year the timeline forpreparation <strong>of</strong> the 2006-2008 triennial<strong>report</strong> was set. It was anticipated thatdata would be received from NSW,Victoria, WA <strong>and</strong> Tasmania. Data areexpected by February 2011, <strong>and</strong> a draft<strong>report</strong> should be available for discussionat the April Mortality Working Groupmeeting. Meanwhile, a request was madeto the <strong>Australian</strong> Institute <strong>of</strong> Health<strong>and</strong> Welfare for data on the number<strong>of</strong> anaesthetics performed in the fourparticipating states over the triennium.Change <strong>of</strong> Quality <strong>and</strong> Safety OfficerIt was with considerable regret that theworking group received the news thatMs Pauline Berryman would not becontinuing in the position <strong>of</strong> Quality <strong>and</strong>Safety Officer. Pauline Berryman hadmade an outst<strong>and</strong>ing contribution to theactivities <strong>of</strong> the group <strong>and</strong>, in particular,to the preparation <strong>of</strong> the 2003-2005triennial <strong>report</strong>. The group welcomedMs Giselle Collins, the new Quality <strong>and</strong>Safety Officer. The group would like tothank both Ms Berryman <strong>and</strong> Ms Collinsfor their assistance <strong>and</strong> contributionsduring the year.Dr Neville GibbsMember <strong>of</strong> Mortality Working GroupAustralia <strong>and</strong> <strong>New</strong> Zeal<strong>and</strong> TripartiteAnaesthesia Data Committee(AnztadC) Pr<strong>of</strong>essor Alan MerryThis committee is a joint initiative<strong>of</strong> ANZCA, the <strong>Australian</strong> Society <strong>of</strong>Anaesthetists (ASA) <strong>and</strong> the <strong>New</strong>Zeal<strong>and</strong> Society <strong>of</strong> Anaesthetists(NZSA). It relates to the <strong>College</strong> throughthe Quality <strong>and</strong> Safety Committee. Itsmedical director is Adjunct Pr<strong>of</strong>essorMartin Culwick, who has provided thefollowing <strong>report</strong>:During <strong>2010</strong>, the ANZTADC continuedto collect data from the pilot sites untilthe pilot phase was completed at theend <strong>of</strong> August <strong>2010</strong>. At this stage, 252incidents had been collected. Threepublications based on these data werereleased in the bulletins <strong>and</strong> newsletters<strong>of</strong> the ANZTADC parent organisations.Presentations or workshops took placeat the following conferences during <strong>2010</strong>.- ANZCA/NZSA CSM in ChristchurchMay <strong>2010</strong>- Victorian 31st <strong>Annual</strong> Combined CMEmeeting, July <strong>2010</strong>, Melbourne- ASA NSC October <strong>2010</strong>, Melbourne.Program development continued withan administration system <strong>and</strong> ananalysis program.At the May <strong>2010</strong> meeting, alerts<strong>and</strong> analysis subcommittees wereproposed. It was decided to combinethese committees into a single AnalysisSubcommittee <strong>and</strong> this subcommitteemet for the first time in October <strong>2010</strong>.A data analyst has been appointed <strong>and</strong>attended the analysis workshops as wellas the ANZTADC meeting in October<strong>2010</strong>.While I was on vacation in the USA inJune <strong>2010</strong>, I arranged to meet with DrRichard Dutton, the Executive Director<strong>of</strong> the Anesthesia Quality Institute (AQI).We were able to exchange ideas relatingto quality <strong>and</strong> safety in anaesthesia <strong>and</strong>agreed in principle to co-operate in thearea <strong>of</strong> incident monitoring as well asother areas <strong>of</strong> patient safety.A proposal to allow electroniccommunication with external s<strong>of</strong>twaresuch as anaesthetic record keepingsystems or patient databases wasproposed at the October <strong>2010</strong> meeting.Such communication was approvedin principle <strong>and</strong> ANZTADC is in theprocess <strong>of</strong> developing suitable agreementdocuments.A proposal was made at the Octobermeeting to allow external analysers tojoin the Analysis Subcommittee. Anagreement has been made in principle<strong>and</strong> suitable agreement documents arebeing developed at present.In October <strong>2010</strong> the web-basedanaesthetic <strong>report</strong>ing system (WebAIRS)program was released throughoutAustralia <strong>and</strong> <strong>New</strong> Zeal<strong>and</strong>. There hasbeen a good response. Twenty-four siteshad completed the registration processby December <strong>2010</strong>, 14 in Australia <strong>and</strong>10 in <strong>New</strong> Zeal<strong>and</strong>. A further 79 havecommenced the process. The lattersites are being followed up <strong>and</strong> <strong>of</strong>feredfurther assistance. The memor<strong>and</strong>um<strong>of</strong> agreement for pilot sites is beingrewritten to suit the change from pilot toregistered site status for organisationssubmitting data to ANZTADC.Offers to present at the 2012 ASM <strong>and</strong>NSC are being made at present.In conclusion, <strong>2010</strong> resulted incontinuing progress for the development<strong>of</strong> WebAIRS by ANZTADC. Release <strong>of</strong>preliminary results has commenced <strong>and</strong>the program has been released. Thereare now 24 sites <strong>report</strong>ing <strong>and</strong> hopefullymany more will complete the processin 2011. ANZTADC has commencedsetting up communication pathways withlike-minded organisations such as theAQI in the US <strong>and</strong> the NPSA in the UK.Presentations have been made at themeetings <strong>of</strong> ANZCA, the ASA <strong>and</strong> NZSAin <strong>2010</strong> <strong>and</strong> are planned to continuein 2011.Adjunct Pr<strong>of</strong>essor Martin CulwickMedical Director ANZTADC26 ANZCA <strong>Annual</strong> Report <strong>2010</strong>ANZCA <strong>Annual</strong> Report <strong>2010</strong> 27