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VIDEO: On-Patient Fires during Monitored Anesthesia Care. Windows Media File: 
Overview
Purpose
The goal of the American Society of Anesthesiologists (ASA) Closed Claims Project is to identify major areas of loss in anesthesia, patterns of injury and strategies for prevention.
Background
The ASA Closed Claims Project began in 1985 under the auspices of the Committee on Professional Liability of the American Society of Anesthesiologists under the direction of Frederick W. Cheney, Jr, MD (chairman). At the time the project was initiated, professional liability insurance was expensive for anesthesiologists and in some states difficult to obtain. The intention of the Closed Claims Project was to identify causes of loss, improve patient safety, and thereby relieve the insurance problem for anesthesiologists. The project is funded by the American Society of Anesthesiologists. The Closed Claims Project is located at the Department of Anesthesiogy of the University of Washington in Seattle.
Methods
The project consists of an in-depth investigation of 7328 closed insurance claims resulting from anesthetic mishaps. Data is gathered in the form of detailed case summaries collected by ASA member anesthesiologists from insurance company claim files. Claims for dental injury, a very common, well understood, and in most cases minor injury, are excluded. Claims in which the basic sequence of events and/or nature of the injury cannot be reconstructed from the information in the insurance files are also been excluded. This results in most cases being collected from mishaps resulting in lawsuits, as files in these cases contain the most extensive information. Cases are collected from throughout the United States on a continuous basis.
The database consists of standardized summaries of each case, including patient information (e.g. age, physical status), surgical procedure and positioning, anesthetic evaluation and technique, events leading to the injury or claim, type and severity of injury, outcome of litigation, and physician evaluations of potential for prevention and appropriateness of anesthesia care. The database also includes a brief narrative summary of each claim, describing the sequence of events and adding any pertinent information not contained in the standardized data collection form.
Special Projects
The ASA Closed Claims Project also conducts studies that focus on specific aspects of professional liability and anesthesia patient safety. In recent years the Project has investigated the reliability of physician judgments of appropriateness of anesthesia care and sources of bias in such judgments. The project is currently collecting data to evaluate the role of the ASA Guidelines for Management of the Difficult Airway in liability. The project is also providing administrative and technical support for the Pediatric Perioperative Cardiac Arrest Registry (POCA) and the Postoperative Visual Loss Registry.
Results
Findings are reported in the scientific literature (see annotated bibliography). Findings have also been presented to various audiences, including ASA Annual Meeting Refresher Course lectures since 1990. Abstracts of these lectures are available in the refresher course booklets distributed to the attendees or by request from the project office. Reprints of published articles are also available from the project office.
Service to ASA Members: Limited special data analysis will be performed free of charge to ASA members upon written request. Written requests must include a telephone number, as most requests require some clarification to assure a useful analysis. Due to limited staff resources, requests are limited to simple analysis of narrowly defined topics. Special data analysis is provided for the education of the membership but is not generally released for publication.