Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project

Abouleish, Amr E.; Vinta, Sandhya R.; Shabot, Sarah M.; Patel, Nikul V.; Hurwitz, Erin E.; Krishnamurthy, Partha; Simon, Michelle

doi:10.1186/s13741-020-00162-4

Perioperative Medicine

Table 3 ASA-approved and institutional-specific examples for ASA PS

From: Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project

ASA PS	Definition	Descriptor (by ASA)	Cardiac	Pulmonary	Renal	Endocrine/GI	Other	Pedi	OB
ASA I	A normal healthy patient						All ages	All ages except premature infants
ASA II	A patient with mild systemic disease	Mild diseases only without substantive functional limitations	Well controlled HTN; mild pulmonary HTN	Current smoker; mild lung disease (asthma, COPD, or OSA)	Chronic kidney disease (GFR > 44 ml/min)	Obesity (30 < BMI < 40); well controlled DM; mild GERD	Social alcohol drinker; History (> 3 months) of cancer unrelated to surgery; psychiatric does not affect daily living	URI > 2 weeks; mild asthma; allergic rhinitis; dental caries; sleep-disturbed breathing (snoring); mild developmental delay (motor or mental)	Uncomplicated pregnancy
ASA III	A patient with severe systemic disease	Substantive functional limitations; one or more moderate to severe diseases	Poorly controlled HTN; implanted pacemaker; moderate reduction in ejection fraction; history (> 3 months) of MI, or CAD/stents; moderate to severe pulmonary HTN	Moderate to severe asthma, COPD, or OSA; on CPAP; on home oxygen	Chronic kidney disease (GFR < 44 ml/min); ESRD undergoing regularly scheduled dialysis	Morbid obesity (BMI ≥ 40); active hepatitis; alcohol dependence; moderate to severe GERD	History (> 3 months) of TIA or CVA cancer related to surgery; recent (< 3 months) cancer unrelated to surgery; psychiatric affects daily living	Former premature infant with PCA < 60 weeks; URI < 2 weeks; Moderate to severe asthma, OSA; moderate to severe developmental delay (motor or mental)	Complicated pregnancy
ASA IV	A patient with severe systemic disease that is a constant threat to life		Recent (< 3 months) MI, or CAD/stents; ongoing cardiac ischemia or severe valve dysfunction; severe reduction of ejection fraction	ARD	ESRD not undergoing regularly scheduled dialysis		Recent (< 3 months) CVA or TIA; sepsis; DIC

Institutional-specific examples were determined in step 2 in reviewing patients with different ASA PS class between PREOP and DOS. The examples were presented and commented on by departmental anesthesiologists. The final institutional-specific examples are italized in the table. ASA-approved examples are not underlined. In step 3, this table was used in education of clinicians (anesthesiologists, residents, nurse anesthetists, nurses in the pre-anesthesia clinic) and posted in the pre-anesthesia clinic
ASA PS ASA physical status class, BMI body mass index, CAD coronary artery disease, COPD chronic obstructive pulmonary disease, CPAP continuous positive airway pressure, CVA cerebrovascular accident, DIC disseminated intravascular coagulation, DM diabetes mellitus, ESRD end-stage renal disease, GERD gastroesophageal reflux disease, GFR glomerular filtration rate, HTN hypertension, MI myocardial infarction, OSA obstructive sleep apnea, PCA post-conceptual age, TIA transient ischemic attack, URI upper respiratory infection

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ISSN: 2047-0525

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