Association Of Anesthesia Clinical Directors Research Articles

Editorial introduction.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Vesna Jevtovic-TodorovicVesna Jevtovic-TodorovicVesna Todorovic is the inaugural CU Medicine Endowed Chair and Chair of the Department of Anesthesiology at the University of Colorado School of Medicine, USA. Dr Todorovic received her graduate education at the University of Belgrade, Serbia (MD) and the University of Illinois, Chicago (PhD), USA and completed residency training in anesthesia at the Washington University School of Medicine in St. Louis, USA. She earned an MBA from the University of Virginia, Charlottesville, Virginia, USA and received the Harold Carron Professor of Anesthesiology Endowment from the University of Virginia Health System during her time on the faculty there. Dr Todorovic is a practicing anesthesiologist and has been working simultaneously as a clinician scientist for over 25 years. Dr Todorovic has developed three major lines of research: anesthetics as neurotoxins, the management of chronic pain and the mechanisms of anesthesia-induced developmental neurodegeneration. Dr Todorovic's research is federally funded and has resulted in over 140 peer-reviewed publications and 11 patents. She has received numerous grants from organizations such as the National Institute of Health, March of Dimes, the American Heart Association and the American Diabetes Association. Dr Todorovic served as the Chair of the National Institute of Health's Surgery, Anesthesiology and Trauma study section. She also serves on the Editorial Board for the Journal of Neurosurgical Anesthesiology and the Associate Editorial Board for British Journal of Anaesthesia. In addition, she serves as an Associate Editor for Anesthesiology. Dr Todorovic was a member of the Board of Directors for the International Society for Anaesthetic Pharmacology from 2007 and served as the Chairman in 2015. In her role as a PI, Dr Todorovic has mentored and trained over 60 graduate students, medical students and post-docs. As Chair of the Department of Anesthesiology, her focus extends to the mentorship and growth of junior faculty, expanding clinical programs, increasing collaboration with the School of Medicine and surrounding community. Richard D. UrmanRichard D. UrmanRichard D. Urman, MD, MBA, FASA is a staff anesthesiologist at the Brigham and Women's Hospital Department of Anesthesiology, Perioperative and Pain medicine in Boston, Massachusetts, USA and Associate Professor of Anesthesia at Harvard Medical School, USA, where he also received his MD and MBA degrees. He serves as Associate Chair for Dana-Farber Cancer Institute, Boston, Massachusetts, USA, and as a Medical Director for Procedural Sedation Services at the Brigham and Women's Hospital. In addition, he is the founding co-Director of the Center for Perioperative Research and the Director of the Perioperative Medicine Fellowship. He has edited a dozen textbooks, including the one on non-operating room anesthesia (NORA) entitled Anesthesia Outside the Operating Room (Cambridge Press, 2018) and has published papers on NORA safety, efficiency and outcomes. He is currently funded by the NIH, NSF, AHRQ and the industry. His research interests include pharmacology, acute pain management, patient safety and efficiency in the perioperative and periprocedural setting. He also serves as the scientific reviewer for the Department of Defense and sits on the FDA Analgesics panel. He is on the editorial boards of the Journal of Clinical Anesthesia and Anesthesia & Analgesia. Dr Urman is active in the Society for Ambulatory Anesthesia, where he serves as Assistant Treasurer and member of the executive committee. He is also Treasurer of the Society for Perioperative Assessment and Quality Improvement (SPAQI) and Treasurer of the Association of Anesthesia Clinical Directors (AACD).

Ethical Considerations for Anesthesia Professionals: Lessons Learned from the Jason S. Lane Leadership Keynote Lecture

Subspecialty News| July 2022 Ethical Considerations for Anesthesia Professionals: Lessons Learned from the Jason S. Lane Leadership Keynote Lecture Andrew A. Serdiuk, DO, MPH, FAACD; Andrew A. Serdiuk, DO, MPH, FAACD Search for other works by this author on: This Site PubMed Google Scholar Rebecca Barnett, MBChB Rebecca Barnett, MBChB Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor July 2022, Vol. 86, 40. https://doi.org/10.1097/01.ASM.0000842104.56081.d5 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Andrew A. Serdiuk, Rebecca Barnett; Ethical Considerations for Anesthesia Professionals: Lessons Learned from the Jason S. Lane Leadership Keynote Lecture. ASA Monitor 2022; 86:40 doi: https://doi.org/10.1097/01.ASM.0000842104.56081.d5 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: ethics, leadership The Association of Anesthesia Clinical Directors (AACD) is an organization rooted in the belief that anesthesiologists are the physicians uniquely qualified to oversee clinical and administrative aspects of a hospital or health care system (asamonitor.pub/3FNwy9Z). Over our nearly 35-year history, the Perioperative Leadership Summit has been a focal point for the organization. This annual event brings together AACD members, anesthesiologists, surgeons, nursing leaders, and others interested in effective perioperative management. We have been fortunate over the years to have so many distinguished speakers deliver the annual Jason S. Lane, MD Leadership Keynote Lecture. This year was no exception. Warren S. Sandberg, MD, PhD, Professor and Chair of Anesthesiology at Vanderbilt University, spoke on “Ethical Considerations for Anesthesia Professionals.” Our moral obligations not only to our patients, but to our colleagues and society as whole, were explored. The recognition that physicians hold a sacred role in society goes back... You do not currently have access to this content.

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Eberhard F. KochsEberhard F. KochsEberhard F. Kochs, MD, PhD, is Professor Emeritus of Anaesthesia and Intensive Care at the Klinikum rechts der Isar, Technical University Munich, Germany. Dr Kochs earned his medical degree from the University of Bonn, Germany and completed his residency at the University Hospital Eppendorf, Hamburg, Germany. In addition, Dr Kochs holds a Masters degree (Dipl.-Phys.) in physics from the University of Bonn. After specializing in anaesthesia and intensive care, he became Professor of Anaesthesiology. In 1994, he was elected as Chair of the Department of Anaesthesiology of the Technical University Munich at the Klinikum rechts der Isar and retired in 2016. Dr Kochs was a member of the Board of Trustees of the Klinikum rechts der Isar and the Klinikum Freising, Germany. In the years 2012–2013, he was President of the European Society of Anaesthesiology (ESA). He served as a member of various editorial boards and has published more than 350 peer-reviewed articles and edited several textbooks in the domain of anaesthesia, intensive care and pain medicine. Dr Kochs’ main areas of research are: neuroscience as applied to anaesthesia, intensive care and pain medicine using electrophysiology combined with neuroimaging, applying mathematical tools for assessment of changes in brain function during drug-induced unconsciousness and following brain pathophysiology (coma). Dr Kochs’ research also focuses on receptor studies including cellular signal transmission in single neurons and brain networks and clinical studies on the effects of sedatives, analgesics on long-term outcome after anaesthesia and intensive care. Richard D. UrmanRichard D. UrmanRichard D. Urman, MD, MBA, FASA is a staff anesthesiologist at the Brigham and Women's Hospital Department of Anesthesiology, Perioperative and Pain Medicine in Boston, Massachusetts, USA and Associate Professor of Anesthesia at Harvard Medical School, USA, where he also received his MD and MBA degrees. He serves as Associate Chair for Dana-Farber Cancer Institute and as a Medical Director for Procedural Sedation Services at the Brigham and Women's Hospital. In addition, he is the founding co-Director of the Center for Perioperative Research and the Director of the Perioperative Medicine Fellowship. He has edited a dozen textbooks, including the one on non-operating room anesthesia (NORA) entitled “Anesthesia Outside the Operating Room” (Cambridge Press, 2018) and has published papers on NORA safety, efficiency and outcomes. He is currently funded by the NIH, NSF, AHRQ and the industry. His research interests include pharmacology, acute pain management, patient safety and efficiency in the perioperative and periprocedural setting. He also serves as the scientific reviewer for the Department of Defense and sits on the FDA Analgesics panel. He is Editor-In-Chief of the Journal of Clinical Anesthesia. Dr Urman is active in the Society for Ambulatory Anesthesia, where he serves as Assistant Treasurer and member of the executive committee. He is also Treasurer of the Society for Perioperative Assessment and Quality Improvement (SPAQI) and Treasurer of the Association of Anesthesia Clinical Directors (AACD). Andrea U. SteinbickerAndrea U. SteinbickerProf. Dr med. Andrea U. Steinbicker is the leading staff physician at the Department of Anaesthesiology, Intensive Care and Pain Medicine at Muenster University Hospital, Muenster, Germany. She has studied medicine at the University of Duisburg-Essen, Alicante, Spain and at Muenster University, Germany. In addition, she studied Public Health and graduated with the master of Public Health. The master thesis was performed at World Health Organization (WHO) in Geneva, Switzerland. She achieved her doctoral degree at the Institute of Physiological Chemistry at the University Duisburg-Essen in 2006. Prof. Steinbicker habilitated in 2015 and was promoted to Associate Professor in 2019. During residency, she performed research as a DFG-funded postdoctoral fellow at the Massachusetts General Hospital, Harvard Medical School, in Boston, Massachusetts, USA and established her research group “Iron signaling“ at Muenster University. She is a certified anaesthesiologist, intensivist and emergency physician. Besides clinical duties, she implemented and coordinates to date Patient Blood Management at Muenster University Hospital in Germany. Until 2021, she was the speaker of the Subcommittee Haemotherapy of the German Society of Anaesthesiology and Intensive Care Medicine and is a member of the International Anesthesia Research Society. Her research focus on iron, blood management and inflammation is pursued in basic, translational and clinical research projects, as well as in education and teaching.

The Association of Anesthesia Clinical Directors (AACD) Glossary of Times Used for Scheduling and Monitoring of Diagnostic and Therapeutic Procedures.

The Glossary of Times Used for Scheduling and Monitoring of Diagnostic and Therapeutic Procedures also known as the Procedural Times Glossary (PTG) was originally developed with the support of the Association of Anesthesia Clinical Directors (AACD). The goal was to establish standardized terms to measure and assess the performance of operating room and procedural areas. By incorporating standardized concepts of efficiency and utilization, the PTG codified operating room metrics and facilitated benchmarking and quality improvement initiatives. In the last three decades, these concepts have also served as the basis for research in operating room management, including incorporating frameworks from diverse fields. The metrics in the PTG are divided into four categories: (1) Procedural Times; (2) Procedural and Scheduling Definitions and Time Periods; (3) Utilization and Efficiency Indices; and (4) Patient Categories. We describe each of the categories and corresponding metrics. The PTG provides the fundamental building blocks for managing operating and non-operating room suites. We hope that reintroducing these important time markers will help facilitate the reporting of standardized metrics.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Ken B. JohnsonKen B. JohnsonKen B. Johnson, MD is an anesthesiologist at the University of Utah, USA. His clinical interests are in acute pain management and anesthetic drug pharmacology. He is the Vice Chair for Research in the Department of Anesthesiology. His research interests are in anesthetic drug interactions, developing pain biomarkers, and medical device development to better capture adverse respiratory events. Dr Johnson has received extramural support from government, foundations, and industry to support his work. He has enjoyed collaborating with researchers in bioengineering, neuroscience, and pharmacology. Dr Johnson's education interests are in screen-based and high-fidelity simulation. He serves as the Co-Director of the Center for Simulation within the Department of Anesthesiology. He directs simulation courses that meet selected requirements for Maintenance of Certification in Anesthesia established by the American Board of Anesthesiology. He is a member of the team that has developed both online and high-fidelity simulation training for moderate and deep sedation endorsed by the American Society of Anesthesiologists. By way of professional service, Dr Johnson is a Section Editor for Anesthesia and Analgesia, a member of the American Society of Anesthesiologist's Simulation Education Editorial Board, and a Part II examiner (oral board examiner) for the American Board of Anesthesiologists. He also serves on the American Board of Anesthesiologists Observed Structured Clinical Examination Development Committee. Mark S. WeissMark S. WeissMark S. Weiss is an Assistant Professor of Anesthesiology and Critical Care at the University of Pennsylvania, USA. He is the Section Chief of Inpatient Endoscopy, and works both in the Operating Room and Non-Operating Room setting. Dr Weiss earned his medical degree from the University of Cincinnati, USA. He completed his Residency at Yale University, USA, after which he completed a Specialization Year in Cardiac and High-Risk Anesthesia. He moved to Penn after several years as a private practice anesthesiologist. The combination of experience, efficiency, and collaboration has led him and his team to develop and implement measures designed to improve patient flow as well as patient care. He is keenly interested in developing standards for patient care and resident education. Since joining Penn, Dr Weiss has written several papers and chapters. He has also been asked to edit several monographs, and is very proud of his current association with Current Opinion in Anesthesiology. Working with Dr Lee Fleisher, Dr Weiss has produced a textbook, Non-Operating Room Anesthesia. Dr Weiss was a founding member of the Society of Non-Operating Room Intervention and Anesthesia (SONORIA), in response to the astounding growth of Non-Operating Room Anesthesia (NORA) cases. SONORIA recently merged with the Association of Anesthesia Clinical Directors (AACD), where Dr Weiss sits on the Board of Directors. In addition to writing, Dr Weiss developed a NORA course for residents at the University of Pennsylvania, one of the first such courses in the United States. Shortly after, the Accreditation Council for Graduate Medical Education (ACGME) mandated the two week NORA rotation for all accredited residency programs. This broad mandate is vague as to what is to be taught. Different programs have different levels of ability or resources to expose residents to the full spectrum of the NORA setting. In order to standardize both anesthesia provider training as well as improve patient care, Dr Weiss, through Penn, has developed an online training program: NORAlink. NORAlink is designed to provide an integrated teaching platform across the spectrum of NORA, through a multi-modal approach. NORAlink has value not only to residency training programs, but can also be the standard teaching tool for the entire anesthesia provider team, including Staff Anesthesiologists, Certified Registered Nurse Anesthetists, and Procedural Physicians supervising the delivery of anesthesia in the NORA setting.

Identification and use of operating room efficiency indicators: the problem of not performing the right search within Pubmed: The authors respond

We thank Dr. Stepaniak for his interest in our commentary on the identification and use of operating room (OR) efficiency indicators. While the Procedural Times Glossary, developed by the Association of Anesthesia Clinical Directors (AACD), is a leading source of procedural time definitions in support of economic and efficiency analyses within the OR, this does not negate the fact that variable performance indicator definitions nonetheless exist in the body of OR efficiency literature. Moreover, despite the availability of leading sources of definitions such as the Procedural Times Glossary, differences in how hospitals define key OR performance indicators persist. Furthermore, even the AACD’s Procedural Times Glossary may not always be adequate if one wants to ensure consistent performance indicator data collection across multiple hospitals. For example, the AACD defines “turnover time” as the “time from prior patient out of room to succeeding patient in room time for sequentially scheduled cases.”1 However, while this definition is clearly meant to exclude idle time between nonsequentially scheduled cases, it does not entirely address potential exclusions, such as delays between sequentially scheduled cases unrelated to room cleaning and preparation (e.g., patient arrives late); how these situations are handled varies significantly across hospitals and materially impacts how the indicator is collected. Another example is the definition of “on-time starts,” defined as the patient being in the OR at the scheduled time.1 This does not consider, however, whether certain late starts should be excluded (e.g., owing to delayed access to postoperative beds, as is the case at some hospitals). Thus, we do believe that there is room for professional associations to agree to develop common metrics and operational definitions, perhaps using the AACD’s Procedural Times Glossary (or an equivalent source) as a starting point, closing any gaps from there. Regarding Dr. Stepaniak’s second point, while performance indicators may not contribute to the effective use of resources as defined by the Institute of Medicine’s Committee on Quality Health Care in America, they may do so under another definition, such as the Oxford English Dictionary, which defines “effective” as “having an intended or expected effect.” If using resources efficiently leads to the most patients having surgery in the best way (i.e., on time starts, no delays, no cancellations), then use of OR performance indicators to monitor operational performance can indeed lead to the effective use of resources. In addition, we also thank Dr. Kazemier and Ms. van Veen-Berkx for their interest in our commentary and note that the Dutch experience, whereby it took 2 years to harmonize OR performance indicator definitions and reporting across 8 university medical centres, speaks to the complexity of the undertaking and the continuing lack of universal standards for indicator definitions. Moreover, some Canadian provinces have also had some success in harmonizing OR performance indicators, such as the OR Benchmarks Collaborative in Ontario. As our commentary has demonstrated, though, variable indicator definitions persist and harmonizing them nationally may be particularly challenging due to the provincial delivery of health care.

Physicians’ perceptions of minimum time that should be saved to move a surgical case from one operating room to another: internet−based survey of the membership of the association of anesthesia clinical directors (aacd)

Study objective Moving the last case of the day from one operating room (OR) to another OR can increase OR efficiency. However, there is a penalty cost for moving a case. The goal of the study was to measure perceptions of the minimum time that needs to be saved for it to be worthwhile to move a case from a late-running OR to another OR. Design Internet-based survey of the Association of Anesthesia Clinical Directors (AACD) and/or attendees at one of its courses. As subjects completed the computer-assisted survey, answers to test questions were checked immediately to ensure respondents understood the relevant concepts. Measurements Respondents were asked to complete the statement: “I would move the case if I would expect to save ____ hours of overutilized OR time.” Main results 234 E-mail invitations to complete the survey were transmitted. Of that number, 87 completed surveys were returned. Respondents were physicians, mostly from the United States. The 25th, 50th, and 75th percentiles of the penalty cost were 1.0 hour of overutilized OR time. The 95% confidence intervals were 0.5 to 1.0 hour for the 25th percentile, 1.0 to 1.0 hour for the 50th percentile, and 1.0 to 2.0 hours for the 75th percentile. There was no significant correlation between the penalty cost and the number of ORs at the respondent’s facility, number of times the survey was submitted until it was completed correctly, or total number of errors in responses. Conclusions Members of the AACD perceive the penalty cost for moving a case to be 1 hour.

Association of Anesthesia Clinical Directors (AACD) Abstracts Presented at the AACD 14th Annual Meeting

Association of Anesthesia Clinical Directors (AACD) Abstracts Presented at the AACD 14th Annual Meeting

The preoperative evaluation form: assessment of quality from one hundred thirty-eight institutions and recommendations for a high-quality form

Study Objective: T o develop a rating system to evaluate the preoperative evaluation form in three categories: informational content, ease of use, and ease of reading; to analyze forms contributed by the Association of Anesthesia Clinical Directors; to offer an example of a more optimal form; and interest practitioners in evaluating the quality of their evaluation forms. Setting: University medical center. Design/Measurements: The informational content of the forms was graded by a rating system developed to give a score based on the importance of the data to anesthesia management and legal documentation. Based on the amount of informational content, the forms were grouped into categories ranging from severely deficient to excellent. The ease of use and ease of reading were determined by specific criteria. Main Results: 138 forms were analyzed. The mean ± SD information score was 265 ± 41, with a range of 140 to 333 (maximum score possible = 363). Fifteen percent of the forms were considered severely deficient to substandard whereas 52% were deemed very good to excellent. A large proportion of forms omitted at least one essential information item. Twelve percent and 6% were labeled poor with regard to ease of use and ease of reading, respectively. Academic centers performed significantly better in the content and ease of use of their forms compared to those from private centers. Conclusions: A good preoperative evaluation form is an important tool in the anesthetic management of a patient and plays a significant role in the medical legal arena. We found that a surprisingly high percentage of forms are missing important information. A form that contains all of the information and also meets our ease of use and reading standards was developed and offered as an example.

Association of Anesthesia Clinical Directors (AACD) abstracts presented at the AACD 13th annual meeting

Association of Anesthesia Clinical Directors (AACD) abstracts presented at the AACD 13th annual meeting

Anaesthesiology directors: more support on the way as Association of Anesthesia Clinical Directors goes international

Anaesthesiology directors: more support on the way as Association of Anesthesia Clinical Directors goes international

Anaesthesiology directors: more support on the way as Association of Anesthesia Clinical Directors goes international

Anaesthesiology directors: more support on the way as Association of Anesthesia Clinical Directors goes international

Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery

Study Objectives: (1) To incorporate regional anesthesia options for common outpatient orthopedic surgery into clinical pathways; (2) to use the clinical pathway format and the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as management tools to measure postoperative same-day surgery processes and discharge outcomes; and (3) to determine the effects of general, regional, and combined general-regional anesthesia on these processes and outcomes. Design: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995–1996 and 1996–1997. Patient data from AY 1995–1996, during which no intraoperative anesthesia clinical pathway existed, served as historical controls. Data from AY 1996–1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Setting: Ambulatory surgery center in a teaching hospital. Measurements and Main Results: The records of 503 ASA physical status I and II patients were reviewed. 1996–1997 patients selected general anesthesia (±femoral nerve block) or epidural anesthesia, after which the remainder of the perioperative anesthesia process was standardized with respect to the drugs and equipment used. 1995–1996 patients did not necessarily have a choice in anesthesia technique and did not have a standardized perioperative anesthetic course with respect to specific drugs and supplies. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by anesthesia technique used, were measured. Combined general-regional anesthesia care for ACLR in 1996–1997, when compared with general anesthesia alone, led to increased pharmacy and materials costs and increased turnover time. However, patients with the combined technique showed improved recovery profiles and lower unexpected admission rates, and they required fewer nursing interventions for common postoperative symptoms. Patients receiving epidural anesthesia showed discharge outcomes similar to those patients receiving general anesthesia with femoral nerve block. Postanesthesia care unit bypass (fast-tracking) was more likely in clinical pathway regional anesthesia patients, when compared with the clinical pathway general anesthesia used. Conclusions: Clinical pathway regional anesthesia care for outpatient orthopedics may have a significant role in simultaneously containing costs and improving both process efficiency and patient outcomes.

Benchmarking the perioperative process: II. Introducing anesthesia clinical pathways to improve processes and outcomes and to reduce nursing labor intensity in ambulatory orthopedic surgery

Study Objectives: (1) To introduce anesthesia clinical pathways as a management tool to improve the quality of care; (2) to use the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as a template for data collection and analysis; and (3) to determine the effects of anesthesia clinical pathways on surgical processes, outcomes, and costs in common ambulatory orthopedic surgery. Design: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995–1996 and 1996–1997. Patient data from AY 1995–1996, during which no intraoperative anesthesia clinical pathways existed, served as historical controls. Data from AY 1996–1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Regional anesthesia options were routinely offered to patients in the clinical pathway. Setting: Ambulatory surgery center in a teaching hospital. Measurements and Main Results: The records of 503 ASA physical status I and II patients were reviewed. 1996–1997 patients underwent clinical pathway anesthesia care in which the intraoperative and postoperative anesthesia process was standardized with respect to symptom management, drugs, and equipment used. 1995–1996 patients did not have a standardized intraoperative and postoperative anesthetic course with respect to the management of common symptoms or to specific drugs and supplies used. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by the use of the anesthesia clinical pathway, were measured. Clinical pathway anesthesia care for ACLR in 1996–1997, which actively incorporated regional anesthesia options, reduced pharmacy and materials cost variability; slightly increased turnover time; improved intraoperative anesthesia and surgical efficiency, recovery times, and unexpected admission rates; and decreased the number of required nursing interventions for common postoperative symptoms. Conclusions: Clinical pathway patient management systems in anesthesia care are likely to produce useful outcome data of current practice patterns when compared with historical controls. This management tool may be useful in simultaneously containing costs and improving process efficiency and patient outcomes.