Anesthetists: Question these treatments
(Editor’s note: We tweeted this information on Oct. 14. To keep up with breaking news as it happens, you can follow us @SameDaySurgery on Twitter.)
The American Society of Anesthesiologists (ASA) has released a list of specific tests or procedures that are commonly ordered but not always necessary in anesthesiology, The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is necessary.
The list was released as part of Choosing Wisely, an initiative of the ABIM Foundation. ABIM seeks to advance medical professionalism to improve the health care system. ASA’s list made the following recommendations:
- Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery — specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.
- Don’t obtain baseline diagnostic cardiac testing (trans-thoracic/esophageal echocardiography — TTE/TEE) or cardiac stress testing in asymptomatic stable patients with known cardiac disease (e.g., coronary artery disease, valvular disease) undergoing low or moderate risk non-cardiac surgery.
- Don’t use pulmonary artery catheters (PACs) routinely for cardiac surgery in patients with a low risk of hemodynamic complications (especially with the concomitant use of alternative diagnostic tools (e.g., TEE).
- Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.
- Don’t routinely administer colloid (dextrans, hydroxylethyl starches, albumin) for volume resuscitation without appropriate indications.
ASA’s Choosing Wisely list development began with a review of relevant ASA literature and practice guidelines. Next, a multi-step survey of physician anesthesiologists in the academic and private sector was conducted and analyzed to generate a "Top 5 List" list of preoperative and intraoperative activities to be questioned. This list was reviewed by ASA committees of jurisdiction, section chairs and division chairs. Lastly the list was endorsed by ASA leadership.
Richard J. Baron, MD, president and CEO of the ABIM Foundation, said, "ASA has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in anesthesiology, but aren’t always necessary. The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need and what we can do to reduce waste and overuse in our health care system."
More than 30 other specialty society partners are releasing Choosing Wisely lists, including a second list from the American Geriatrics Society on Feb. 27, 2014. At an undetermined date, a list also will be released by the American Society of Colon and Rectal Surgeons.
To date, more than 80 national and state medical specialty societies, regional health collaboratives, and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.
To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit ChoosingWisely.org. (For lists released by the American College of Surgeons/Commission on Cancer and the American Academy of Orthopaedic Surgeons, see Same-Day Surgery, November 2013, p. 128.)