Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting.

BACKGROUND: The American Society of Anesthesiologists (ASA) physical status is a universal classification system that helps clinicians to categorize their patients preoperatively. However, there is a lack of both inter-rater and intra-rater reliability among clinicians for the ASA physical status classification. Our study focuses on testing these reliabilities within pediatric anesthesia providers in the cancer setting. METHODS: In our retrospective observational study, a total of 1177 anesthesia records were reviewed. The cohort included all pediatric patients (≤ 18 years old) diagnosed with either retinoblastoma or neuroblastoma who had two or more anesthesia procedure within a 14-day time period. RESULTS: Overall, the ASA physical status score among two different anesthesia providers for the same patient treated at different times had very little inter-rater reliability, κ = - 0.042 (95% CI - 0.17; 0.09). Of the 1177-patient anesthesia records, only 25% had two or more ASA physical status score assigned by the same anesthesiologist within a 14-day time period. There was moderate intra-rater reliability κ = 0.48 (95% CI 0.29; 0.68) for patients who were assigned an ASA physical status score by the identical anesthesia provider at different times points within a 14 day period. CONCLUSION: In contrast to observations in earlier studies, findings indicate poor agreement in inter-rater reliability. Although there was moderate agreement in intra-rater reliability, one would expect to find stronger, even perfect, intra-rater reliability. These findings suggest the need to develop a specific physical status classification system directed toward patients with a systemic illness such as cancer in both young and adult patients.

Does Checklist Implementation Improve Quantity of Data Transfer: An Observation in Postanesthesia Care Unit (PACU).

BACKGROUND: Omission of patient information in perioperative communication is closely linked to adverse events. Use of checklists to standardize the handoff in the post anesthesia care unit (PACU) has been shown to effectively reduce medical errors. OBJECTIVE: Our study investigates the use of a checklist to improve quantity of data transfer during handoffs in the PACU. DESIGN: A cross-sectional observational study. SETTING: PACU at Memorial Sloan Kettering Cancer Center (MSKCC); June 13, 2016 through July 15, 2016. PATIENTS OTHER PARTICIPANTS: We observed the handoff reports between the nurses, PACU midlevel providers, anesthesia staff, and surgical staff. INTERVENTION: A physical checklist was provided to all anesthesia staff and recommended to adhere to the list at all observed PACU handoffs. MAIN OUTCOME MEASURE: Quantity of reported handoff items during 60 pre- and 60 post-implementation of a checklist. RESULTS: Composite value from both surgical and anesthesia reports showed an increase in the mean report of 8.7 items from pre-implementation period to 10.9 post-implementation. Given that surgical staff reported the mean of 5.9 items pre-implementation and 5.5 items post-implementation without intervention, improvements in anesthesia staff report with intervention improved the overall handoff data transfer. CONCLUSIONS: Using a physical 12-item checklist for PACU handoff increased overall data transfer.