Choosing wisely in anesthesiology: the gap between evidence and practice

Area of Science:

• Anesthesiology
• Health Services Research
• Medical Quality Improvement

Background:

• Identifying and reducing low-value medical services is crucial for improving healthcare quality and efficiency.
• Anesthesiology encompasses a wide range of perioperative activities, some of which may not provide sufficient benefit to justify their cost or resource utilization.

Purpose of the Study:

• To develop a "top-five" list of unnecessary medical services in anesthesiology.
• To identify common perioperative activities with low quality, minimal benefit, high cost, and weak supporting evidence.

Main Methods:

• A multistep survey of anesthesiologists, primarily from academic practice.
• An iterative process involving committees of the American Society of Anesthesiologists.
• A 2-step survey using a 5-point Likert scale questionnaire on a list of 18 low-value perioperative activities.

Main Results:

• Five common anesthesiology activities were identified as low-value.
• Preoperative practices included avoiding unindicated baseline laboratory studies and diagnostic cardiac stress testing.
• Intraoperative practices included avoiding routine pulmonary artery catheter use in cardiac surgery and unnecessary use of packed red blood cells or colloid.

Conclusions:

• The study successfully identified a "top-five" list of unnecessary medical services in anesthesiology.
• These findings can guide efforts to reduce low-value care, optimize resource allocation, and improve perioperative patient management.
• Implementation of these recommendations may lead to significant cost savings and enhanced quality of care.