Anesthesia Patient Safety Podcast

#260 OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education Innovation

• Anesthesia Patient Safety Foundation

Share episode

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

Marjorie Striegler:

You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.

Alli Bechtel:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. Today we have Elizabeth Malenzack, a pediatric anesthesiologist and associate professor at Duke University and the Open Anesthesia liaison to the Anesthesia Patient Safety Foundation, joining us for a very special interview show. We have talked about open anesthesia on the podcast before.

Alli Bechtel:

Open anesthesia is a great resource for educational content related to anesthesia care, perioperative care and critical care. Keeping up to date with a strong knowledge base is vital for keeping patients safe during anesthesia care. We hope that you will head over to openanesthesiaorg and check out their podcasts, mini reviews, additional resources and summaries on patient safety and quality improvement topics. We are going to talk more about these summaries today with Malinczak. Before we dive further into the episode, we'd like to recognize Eagle, a major corporate supporter of APSF. Eagle has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, eagle. We wouldn't be able to do all that we do without you. And now my interview with Elizabeth Malenzack. Thank you so much for joining me this morning and to start us off, could you introduce yourself and just tell us a little bit about your background, your training, career, and then lead us into your current role.

Elizabeth Malinzak:

Oh, absolutely. Thank you for having me today. I'm very excited to be a part of this podcast. My name is Elizabeth Malenzak. I am a pediatric anesthesiologist at Duke University. I trained at Duke as well and then I did my pediatric anesthesia fellowship at UNC and I've been on faculty at Duke for over 10 years now. I have been very invested in medical education during the course of my career, been very invested in medical education during the course of my career, and currently serve as Associate Dean for Student Affairs in Duke University School of Medicine. I've always had a variety of academic interests, ranging from gender equity to leadership and professional development, to medical education, to well-being, and ultimately, this all kind of got wrapped up in patient safety as well. So that's how I got involved with APSF was first through some social media and then through some committees involving education, and then ultimately it led me to become the APSF liaison to open anesthesia, which is why I'm here today.

Alli Bechtel:

Oh, that's very exciting. It's always interesting to hear how people get interested in anesthesia, patient safety and their path here, because it comes in all different ways and often something that develops over the course of a career and then for some people starts right at the beginning, and so that's kind of exciting to hear that path. Can you tell us more about your work with Open Anesthesia and the Open Anesthesia summaries? Absolutely.

Elizabeth Malinzak:

So Open Anesthesia has been a well-established website for many years.

Elizabeth Malinzak:

I remember using it as a resident to review keywords when I was studying for my board exams and recently it has gone over an entire redesign in the last few years and started to expand from keywords to Open Anesthesia summaries, which are high-yield topics, not just directed at residents or other trainees but at anyone who's interested in anesthesiology.

Elizabeth Malinzak:

So I was approached by APSF to see if I'd be interested in being the liaison to open anesthesia because of my interest in the roles that I played in medical education, my interest in simulation as I used to run one of our MOCA courses and ultimately to develop this curriculum that would go through patient safety and quality improvement for these open anesthesia summaries.

Elizabeth Malinzak:

So this was kind of a big undertaking because I'd never done anything like this before. I wanted to make sure to incorporate all aspects of the APSF patient safety priorities. So that's where I actually started. When I was developing the curriculum I used those 10 priorities and the resources that were on the APSF website from summaries of the Stolting Conference to this podcast, to many other things and videos that were on the APSF website and then I looked through all the old keywords that were on open anesthesia to see if any were related to patient safety and quality improvement. There actually weren't very many, so I created this curriculum from scratch to expand the educational value of open anesthesia, since patient safety and quality improvement is becoming much more important, not just to our trainees but to anesthesiologists in general.

Alli Bechtel:

Oh, that's great. Wow, what a big undertaking and it's really exciting. Do you remember the very first summary that you started with?

Elizabeth Malinzak:

Oh gosh, no, I actually don't. So the way it kind of evolved is I created the outline for all of the summaries, starting with the APSF perioperative patient safety priority list, and then I went out to recruit authors on some of those topics. So I went through APSF to recruit some of the authors. I'm on the Committee for Education and Training, so I started there because those people are very interested in improving patient safety, education, quality improvement, education. But there were a lot of topics and we've already published over 30. And there's still many more that I have on my topic list to recruit authors for.

Elizabeth Malinzak:

So I also went to social media and gave opportunities through Facebook groups where I'm part of, anesthesiologists who are interested in medical education or in patient safety to see if they're interested in this sort of opportunity. Because these are peer-reviewed summaries, they are things that can go on your CV. It's actually a really good activity for mentoring as well. So many of our authors have been more senior anesthesiologists but have mentored a trainee through writing one of these so that they get that writing experience and they're able to create a really concise summary of an important topic. And yeah, people were just coming out of the woodwork volunteering for these, I actually had to turn some people away, and since that time I have developed even more topics through suggestions by other authors, especially many who've had formal training and quality improvement, as I don't have that expertise at all, and so I've learned a lot through them about other topics to incorporate.

Alli Bechtel:

When you're working with the authors and designing this project. Who was your target audience and has that changed now that you have 30 summaries and you're continuing to work on this resource?

Elizabeth Malinzak:

Yes, well, initially I think the target audience was more to that resident fellow trainee level, as that's how the initial keywords on open anesthesia were set up. But as I was developing this curriculum and kind of going through the different topics and coming up with ideas, I realized that a lot of these topics are things that myself included was not taught in residency. It may be part of their curriculum. Now, as you'll look on the ABA outline, you'll see places there that have quality improvement topics as well, as I think in the ACGME milestones they have to have quality improvement as part of one of those as well.

Elizabeth Malinzak:

But I never learned a lot about these sort of things.

Elizabeth Malinzak:

There's a lot of more non-technical skills, a lot of things related to crisis resource management, simulation, fatigue, burnout, handovers.

Elizabeth Malinzak:

These are sorts of things I never got formal education in. So I assume a lot of other anesthesiologists my age and older also don't have formal education in it. So the audience kind of became more of just general anesthesiologists out in practice who may need to learn more about these topics to move up in hospital leadership positions, to improve their practice areas, to you know if they're starting a new service or a new service line. They want to learn more about patient safety aspects and what they should be watching out for. They want to learn more about patient safety aspects and what they should be watching out for if they have maybe an RCA a root cause analysis over a safety issue and what they can do systematically to help improve it based on whatever the issue was. So it's kind of become more of a resource for the general anesthesiologist, who may not have the expertise from their formal education, but they want to be able to start learning about topics and get high yield information very quickly.

Alli Bechtel:

There's definitely so much to learn and keep learning throughout our careers as anesthesia professionals. Now, you have touched on this, but I just thought we could kind of think about this a little bit more, especially using your areas of expertise with education and in your work as a liaison between the open anesthesia and the APSF. But broadly, how do you envision that anesthesia professionals can best stay up to date throughout their careers, and what do you envision as the relationship between education and patient safety, and is there a way anesthesia professionals should be thinking about this at different stages in their career? Oh, that's a?

Elizabeth Malinzak:

really that's a tough question to answer. I think as generations come out of anesthesia training, certainly they learn differently. They have different ways that they want to get information. It's not sitting down and reading a textbook, you know. Frankly, no one does that anymore. I can't remember the last time I even opened a textbook. We're in this place where there's constant streams of information coming at us. We can just Google something and find it out, but you know that's not always the most vetted information and it's not always the most concise way to learn something. So, having a resource that's online, that you can search easily, that you can look up topics and it only takes a few minutes to read about it, that is how people are learning now Watching videos, listening to podcasts. It really is about the different learning styles that work for people, whether they're verbal, visual, if it's something that they can do. So this is another way for those who are visual, learners can really pick something up in a short period of time, can really pick something up in a short period of time.

Elizabeth Malinzak:

So, in terms of patient safety education, we're constantly evolving With quality improvement. We're starting to learn from this reactive idea to trying to be more proactive at preventing safety issues from happening. So it used to be that something would happen let's say a wrong-sided block and then you would sit down and analyze why did it happen? What are the processes involving human factors or system factors? What are the things we can address and we can fix?

Elizabeth Malinzak:

What I see moving forward with patient safety and how we're going to start to think about it more in the future is how can we be proactive so as new technologies come out, for example, artificial intelligence? As that comes out, how can we adapt that as anesthesiologists? How can we do it in a safe manner for our patients? What are the potential pitfalls that we're thinking about that might be coming down the line? How can we use it to be more efficient and protect our patients? You know, I think that's where we really need to start heading in the direction of quality improvement and safety and, rather than reacting to events that happen, thinking of how we can use new technologies, new drugs, whatever it is going forward and try to anticipate before the patient safety event happens. I hope that answered the question.

Alli Bechtel:

That was amazing, and I think I gave you three questions packaged up into that, so that was fantastic insight. I really like that. Now, if we just go back to the very beginning though, because I think it's probably a little bit different the way trainees think about patient safety and quality improvement and, like you said, you know, when we were training this wasn't a big part of our curriculum, and there is so much for anesthesia trainees to learn about, just the technical skills, the medications. You know everything, but I do think it's really important that patient safety and quality improvement have a role into that. But how do you envision patient safety and quality improvement fitting into all those many demands of training?

Elizabeth Malinzak:

Oh, yes, I mean, there is so much to learn as an anesthesiology resident now I can't imagine how they just do it within three years, because it really has expanded from just medical knowledge and things that you actually needed to know about pharmacology, physiology to really more about how are we a leader in the operating room, how are we doing things to improve our patient care, and so that's a lot to take on. Again, those are things you can't just learn in a textbook, you can't just sit down and read. I know a lot of our trainees, particularly at our program, are interested in quality improvement. They like being able to fix things, but they don't necessarily want to do like basic science or clinical research. They want to do something that has a real impact on their day-to-day life and on their patient's day-to-day life.

Elizabeth Malinzak:

But there's not nearly enough time in training to get formal education in quality improvement, and so it's kind of nice to have these summaries so that they can sit down and say, okay, I found something I want to improve and do a quality improvement project in my hospital, but I don't know anything about quality improvement or methodology things like that, and then they can sit down and learn about what Plan Do Study Act is or other sorts of you know, six Sigma, other sorts of frameworks to work on quality improvement and be able to actually accomplish that as a trainee be able to have a quality improvement project that is meaningful, that actually follows, you know, verified, systematic ways to do it without having completed a course or a certificate or anything.

Elizabeth Malinzak:

In quality improvement. I see that you know interest in safety, patient safety. Quality improvement is becoming part of the daily routine for our trainees as they come into practice and being something that they want to always be learning about and improving and bringing new techniques to improve the practices they go into, rather than being someone who's assigned something as you need to go fix this. So hopefully some of these summaries can give trainees a background when they don't have enough time to learn it formally during their training.

Alli Bechtel:

And there is that idea of being proactive and thinking kind of as they go into their practice. How can I deliver safe and quality anesthesia care rather than delivering care and then retrospectively looking at it and say, oh, was that the safest and the best care we could do? Okay, now how can we fix it? And that is exciting that trainees are trying to approach it right from the very beginning too, and it sounds like the open anesthesia summaries are such a great resource For any of our listeners. If you were listening to those quality improvement terms that Elizabeth just mentioned, we will link to the open anesthesia summaries in the show notes so you can go check those out as well. Now, elizabeth, do you have a favorite summary?

Elizabeth Malinzak:

well, now, elizabeth do you have a favorite summary? Oh, I mean there's so many good ones it's hard to pick just one. So I think I have like two kind of categories of the various patient safety summaries that I enjoy. So I mean a big one I've kind of already talked about is like process improvement and quality improvement. I mean mean a big one I've kind of already talked about is like process improvement and quality improvement. I mean that's something again I've never had formal training in and so I learned a bunch about it through coordinating authors, finding experts who know about these topics, who can write really great concise summaries.

Elizabeth Malinzak:

So it's given me a little bit of education, so I do enjoy all of those. You know, there were some concepts that were suggested to me from these people that I've recruited as authors, like resilience engineering, that I never even heard of. So I love that kind of category of patient safety summaries that are about topics that I just don't know much about. But I think the other ones that I find really interesting kind of the other category are the ones about like, what are we doing now in the operating room to make things better for us as physicians, as anesthesiologists, rather than just focusing on patient care? So things like sustainability in health care, like how do we make sure that we're doing the best for our environment, that we are preventing?

Elizabeth Malinzak:

There's another one on occupational health. So how are we preventing exposures, how are we taking care of ourselves and preventing anything from happening in terms of injuries? We have one coming out later about needle stick injuries. There's also things about fatigue, burnout, wellness, how to improve teamwork and communication. So I like those two because patient safety is more than just about the patient. It is about taking care of ourselves, creating that culture of safety so that we can be better anesthesiologists for our patients and outcomes can be better.

Alli Bechtel:

Absolutely, and actually the number one perioperative patient safety priorities this year is culture of safety, teamwork and clinician safety, which includes all of those really important topics that you just mentioned. So we will definitely put some links to those open anesthesia summaries as well. And I had another question. So a lot of times we talk about anesthesia, patient safety, and then we talk about quality improvement, and they're similar topics, but I was just wondering how you think about the relationship between patient safety and quality improvement in their separate entities.

Elizabeth Malinzak:

Yes. So to me, patient safety is the goal right. That is what we are aiming for when we take care of our patients. That's why many of us became anesthesiologists is because we see surgery can be a very vulnerable time for our patients. There's a lot that can happen and you know, sometimes, as a pediatric anesthesiologist, I'll describe myself as like the guardian angel for the child in the operating room. That's sometimes what I tell their parents. So I feel like patient safety is always the goal. That's what we want. That's what we want to accomplish with every single patient that we take care of.

Elizabeth Malinzak:

I see quality improvement more as the process. So it's how we get to the goal. It's how we ensure that what we are doing on a daily basis is consistent, is reliable. If there are things that come in the way that can trip us up in the operating room, how we can handle that in the future. Again, a little bit of that is being reactive.

Elizabeth Malinzak:

So if something happens, how can we do better next time to get to the goal of patient safety and how do we continue to look at it over a course of time to make sure that we're continuing to stay educated, that we're up to date on our technical skills, that we're up to date on processes and comorbidities of patients. So I think that's how I view it. I always view patient safety as what we want to do. It's a good buzzword. It's like what we always think about, that we are the protectors of it. But quality improvement is the way we continue to evolve to make sure that we are the protectors of it. But quality improvement is the way we continue to evolve to make sure that we are those gatekeepers of patient safety.

Alli Bechtel:

Oh, wow. That is such great insight and a really nice and simple way actually to think about it, with patient safety as the goal and then quality improvement as the process to reach that goal. You have talked about this because we're forward thinking throughout this whole discussion, but is there anything else you really hope to see going forward when it comes to quality improvement, safe anesthesia care and education?

Elizabeth Malinzak:

I think we all need to learn more about it. To be perfectly honest, I think you know. I think you know you look back on kind of the history of patient safety and quality in anesthesia or in pediatric anesthesia. You think about how we have improved mortality and morbidity in our patients. You think about all the different interventions in terms of monitoring that have come through over the course of the years and we just continue to get better and better at what we're doing and making sure that our patients are staying as safe as possible.

Elizabeth Malinzak:

We are able to do sicker patients now.

Elizabeth Malinzak:

We're able to do much bigger cases than we used to be able to and I think we're going to see that getting even heavier.

Elizabeth Malinzak:

We're going to see, you know, us really getting pushed in terms of pressure to take care of more patients as the healthcare system evolves to, you know, do more cases, and that can become distracting.

Elizabeth Malinzak:

That can really start to change the mindset of us as anesthesiologists.

Elizabeth Malinzak:

So where I'm kind of going with that is what I would really like to see is, as we are taking care of sicker patients that require more of our attention, that we can develop new technologies or new ways to really make us be more efficient and reduce cognitive fatigue that we have with the many streams of information that are coming into our brains, so that we don't miss something, so that we are making sure that our patients are safe in the operating room, that we're not distracted by something that's going on or that we're taking care of too many patients at once, that we can't give them the individualized care that they need. So I mentioned artificial intelligence earlier. I do think that AI LLMs, machine learning is going to become really important in terms of our charting, our documentation, going through the chart, creating pre-ops, doing a lot of elements to kind of take the administrative workload off of us as anesthesiologists so that we really can focus on using the space in our brains for actual patient care. So that's what I hope for in terms of the future of quality improvement.

Alli Bechtel:

Oh, I hope for that also. That sounds great.

Elizabeth Malinzak:

Yes, I know. Wouldn't it be nice to just be able to tell your chart what you're giving voice recognition and it charts it for you so you can just monitor the patient?

Alli Bechtel:

the whole time and then flag it if it's like no, are you sure that's what you wanted to do?

Elizabeth Malinzak:

Yes, yes, you know a turnaround is like there's a lot of alarm fatigue too, but if there's a way we can use these technologies to really just ease our workload so that we are focusing on the medicine and the diagnosis, prevention and treatment of patients, rather than all the little charting tasks we have to do, absolutely.

Alli Bechtel:

So what's next for your research or projects or anything upcoming?

Elizabeth Malinzak:

there's always something going on. That's the life of being in academics. You know, in terms of open anesthesia summaries, we're continuing to expand on topics. You know, allie, you did a podcast with one of our open anesthesia authors for one of the patient safety summaries, so I'm hoping we'll continue that collaboration and continue to build that as well. Other projects that I have going on I actually have an article about the past, present and future of safety and pediatric anesthesiology that will be coming out in the APSF newsletter for its 40th anniversary. So that's very exciting. And there's always some sort of project that I'm working on. I'm finishing up my fair grant right now, which is looking at confidence in MOCA minute participants, so that should be exciting data that will be coming out as well. And then in the medical school side, I'm always going through a residency application process. So we just had Match Day a few months ago and we are getting ready to start our rising MS4s to thinking about where they're going to apply to residency.

Alli Bechtel:

Oh, wow, that is a lot, but it's very exciting for me because we cannot wait to feature your APSF article on the podcast, so we'll have to have you back in a little bit. Is there anything else that you want to share that we haven't talked about already?

Elizabeth Malinzak:

Oh, I think you covered so much already that I don't think I have much else to add. I'm just grateful to be here. I hope people use the patient safety summaries now that they know that they exist. They're very easy to filter out on the website. There's a great way to just click patient safety in terms of the topics, and there's so many of them that come up, so you never know which one might be the one that's going to teach you something new today.

Alli Bechtel:

I love that and we are looking forward to highlighting more of the open anesthesia summaries on the Anesthesia Patient safety podcast soon, so stay tuned for that. Thank you so much for joining us on the show today. It was wonderful learning all about patient safety, quality improvement and education.

Elizabeth Malinzak:

Oh, thank you for having me, ali, till next time.

Alli Bechtel:

Thank you so much to Malinczak for joining us on the show today and for all of your hard work with the Open Anesthesia Summaries. This is an awesome resource for all anesthesia professionals who are interested in providing quality anesthesia care and improving patient safety. I will include links to the Open Anesthesia Summaries in the show notes and we hope that you will check them out and share them with your colleagues. If you have any questions or comments from today's show, please email us at podcast at APSForg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSForg for detailed information and check out the show notes for links to all the topics we discussed today.

Alli Bechtel:

The June 2025 APSF newsletter has been released. We are so excited to feature many of these excellent articles here on the podcast. So excited to feature many of these excellent articles here on the podcast. In the meantime, you can check out the articles online over at APSForg and click on the newsletter heading. The first one down is the current issue, which is now the June 2025 APSF newsletter. Stay tuned for all new podcast episodes on these articles coming soon. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.