The American Society of Anesthesiologists (ASA) today released a list of specific tests or procedures that are commonly ordered but not always necessary in anesthesiology as part of Choosing Wisely®, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.
ASA’s list identified the following five 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., CAD, 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 members are on the front lines of providing the highest-quality and safest patient-centered anesthesia care. We are eager to engage patients and other physicians in conversations about what medical tests and treatments are necessary and beneficial to patient health,” said ASA President Elect Jane C. K. Fitch, M.D. “Physician anesthesiologists have taken the lead in improving patient safety related to surgery and anesthesia. The recommendations in anesthesiology released today support and supplement that patient safety focus and provide valuable information to help patients and physicians start important conversations.”
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 both the academic and private sector was conducted and analyzed in order 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. As physician anesthesiologists, ASA members are ideally suited to engage stakeholders in the perioperative team in an effort to reduce over-utilization of low value, non-indicated medical services evident in the U.S. health system today.
“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,” said Richard J. Baron, M.D., president and CEO of the ABIM Foundation. “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.”
Over the next year, more than 30 other specialty society partners will release Choosing Wisely lists, including:
• September 4, 2013 - AMDA – Dedicated to Long Term Care Medicine
• September 4, 2013 - American College of Surgeons
• September 4, 2013 - Commission on Cancer—a multidisciplinary program of the American College of Surgeons
• September 11, 2013 - American Academy of Orthopaedic Surgeons
• September 12, 2013 - Society of General Internal Medicine
• September 20, 2013 - American Psychiatric Association
• September 23, 2013 - American Society for Radiation Oncology
• September 24, 2013 - American Academy of Family Physicians**
• September 26, 2013 - American College of Medical Toxicology and the American Academy of Clinical Toxicology
• October 8, 2013 - American Association for Pediatric Ophthalmology and Strabismus
• October 9, 2013 - North American Spine Society
• October 14, 2013 - American College of Emergency Physicians
• October 16, 2013 - American Association of Clinical Endocrinologists/The Endocrine Society
• October 27, 2013 - American College of Chest Physicians/American Thoracic Society (Pulmonary)
• October 27, 2013 - American College of Rheumatology*
• October 29, 2013 - American Academy of Dermatology
• October 29, 2013 - American Society of Clinical Oncology*
• October 31, 2013 - Society of Gynecologic Oncology
• November 21, 2013 - American Headache Society
• December 4, 2013 - American Society of Hematology
• January 11, 2014 - American Association of Critical-Care Nurses/American College of Chest Physicians/American Thoracic Society/Society of Critical Care Medicine (Critical Care)
• February 3, 2014 - Society for Maternal-Fetal Medicine
• February 10, 2014 - Heart Rhythm Society
• February 24, 2014 - American College of Occupational and Environmental Medicine
• February 27, 2014 - American Geriatrics Society*
• February 28, 2014 - American Academy of Allergy, Asthma & Immunology
• TBD - American Association of Neurological Surgeons
• TBD - American Society for Reproductive Medicine
• TBD - American Society of Colon and Rectal Surgeons
• TBD - Society for Cardiovascular Angiography and Interventions
• TBD - Society for Cardiovascular Magnetic Resonance
* Releasing a second list
** Releasing a third list
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.
The campaign also continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:
• Alliance Health Networks
• Midwest Business Group on Health
• Minnesota Health Action Group
• National Business Coalition on Health
• National Business Group on Health
• National Center for Farmworker Health
• National Hospice and Palliative Care Organization
• National Partnership for Women & Families
• Pacific Business Group on Health
• The Leapfrog Group
• Union Plus
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.