At their annual meeting on Oct. 12, the American Society of Anesthesiologists (ASA) presented a “Choosing Wisely” list as they join the “Choosing Wisely” campaign initiated by the American Board of Internal Medicine (ABIM) Foundation. The challenge, that has now been met, not just by the ASA but also by more than 50 other national medical organizations, was to come up with five commonly used tests or procedures within a specialty that should be evaluated for necessity before going ahead with the treatment.

Choosing Wisely - ABIM Foundation

“We want to be good stewards of our healthcare dollars. This whole campaign is about saying maybe we [physicians] shouldn’t be doing some things we’ve always done.” – Dr. Lee Fleisher, MD

According to the ABIM Foundation, the goal of the “Choose Wisely” lists is to be a starting point for conversations between patients and physicians to ensure that the treatment decided upon is evidence based, not duplicated services, and is safe and medically necessary.

When commenting on the ASAs participation with the initiative, Dr. Lee Fleisher, MD, retired chair of the ASA Committee on Performance and Outcome Measures said, “We want to be good stewards of our healthcare dollars. This whole campaign is about saying maybe we [physicians] shouldn’t be doing some things we’ve always done.”

Through the review of anesthesiology literature, surveys, and a final review by ASA committee and sections leaders, the ASA endorses the five recommendations.

Five Things Physicians and Patients Should Question

  1. “Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA l or ll) undergoing low-risk surgery specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is /are expected to be minimal.”

  2. “Don’t obtain baseline diagnostic cardiac testing (trans-thoracic/esophageal echocardiography TTE/TEE) or cardiac stress testing in asymptomatic stable patients with knowncardiac disease (e.g., CAD, valvular disease) undergoing low or moderate risk non-cardiac surgery.”

  3. “Don’t use pulmonary artery catheters (PACs) routinely for cardiac surgery in patients with a low risk of hemodynamiccomplications (especially with the concomitant use of alternative diagnostic tools (e.g., TEE).”

  4. “Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin equal or greater than 6 g/dL unless symptomatic or hemodynamically unstable.”

  5. “Don’t routinely administer colloid (dextrans, hydroxylethyl starches, albumin) for volume resuscitation without appropriate indications.”

According to Dr. Fleischer, the implementation of this list will involve cooperation and collaboration from a multidisciplinary healthcare team, and that there will not always be total agreement concerning these suggestions. But he went on to say, “It’s a starting place for discussion.” Both the ASA and the ABIM Foundation agree that patients also need to be a part of these discussions; they need to be better informed and participate in the decision making process so that they get only the necessary and appropriate treatment for their medical situation. And, for this to happen, everyone needs to “choose wisely.”

Written By Donna Pleis


Donna Pleis graduated from the University of Pittsburgh’s dental hygiene program and practiced clinical hygiene for 18 years. After obtaining a business degree, she spent 16 years in management within the medical/dental insurance industry.



abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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