Abstract
BackgroundThe American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the preoperative assessment. In early 2013, the Department of Anesthesia was notified that the distribution of ASA PS scores for sampled patients at the University of Iowa had recently begun to deviate from national comparison data. This change appeared to coincide with the transition from paper records to a new electronic Anesthesia Information Management System (AIMS). We hypothesized that the design of the AIMS was unintentionally influencing how providers assigned ASA PS values.MethodsPrimary analyses were based on 12-month blocks of data from paper records and AIMS. For the purpose of analysis, ASA PS was dichotomized to ASA PS 1 and 2 vs. ASA PS >2. To ensure that changes in ASA PS were not due to “real” changes in our patient mix, we examined other relevant covariates (e.g. age, weight, case distribution across surgical services, emergency vs. elective surgeries etc.).ResultsThere was a 6.1 % (95 % CI: 5.1–7.1 %) absolute increase in the fraction of ASA PS 1&2 classifications after the transition from paper (54.9 %) to AIMS (61.0 %); p < 0.001. The AIMS was then modified to make ASA PS entry clearer (e.g. clearly highlighting ASA PS on the main anesthesia record). Following the modifications, the AS PS 1&2 fraction decreased by 7.7 % (95 % CI: 6.78–8.76 %) compared to the initial AIMS records (from 61.0 to 53.3 %); p < 0.001. There were no significant or meaningful differences in basic patient characteristics and case distribution during this time.ConclusionThe transition from paper to electronic AIMS resulted in an unintended but significant shift in recorded ASA PS scores. Subsequent design changes within the AIMS resulted in resetting of the ASA PS distributions to previous values. These observations highlight the importance of how user interface and cognitive demands introduced by a computational system can impact the recording of important clinical data in the medical record.
Highlights
The American Society of Anesthesiologists Physical Status classification (ASA American society of Anesthesiologists physical status classification (PS)) of surgical patients is a standard element of the preoperative assessment
We examined the distribution of Anesthesiologists Physical Status classification (ASA PS) scores as recorded on paper records for a 12-month period of time prior to Anesthesia Information Management System (AIMS) transition and a similar 12-month period after that transition
The fraction of patients classified with an “E” modifier in the ASA PS score increased from 8.3 % in the paper group to 11.8 % in the AIMS group (p < 0.001), though there was no significant increase in the patients classified as emergency add-ons in the surgical booking system: 12.6 % vs. 12.9 % (AIMS); p = 0.597
Summary
The American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the preoperative assessment. In early 2013, the Department of Anesthesia was notified that the distribution of ASA PS scores for sampled patients at the University of Iowa had recently begun to deviate from national comparison data. This change appeared to coincide with the transition from paper records to a new electronic Anesthesia Information Management System (AIMS). The American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the anesthesiologist’s preoperative assessment. Strong associations between ASA PS and perioperative outcomes (including mortality) has lead to the ASA PS becoming an important part of the risk-adjustment algorithms being used by many organizations to compare
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