In a move designed to encourage conversations between patients and physicians across multiple disciplines, the American Society of Anesthesiologists (ASA) has released a list of common medical practices it says are not always necessary.

Part of Choosing Wisely, a multiyear initiative of the American Board of Internal Medicine (ABIM) Foundation, the ASA’s list includes 5 evidence-based recommendations of tests and procedures for which patients and doctors should question the necessity because they most often do not add value. The ASA issued the Choosing Wisely list, its first, on October 12, the first day of its annual meeting here.

We want to be good stewards of our healthcare dollars.Dr. Lee Fleisher

“We want to be good stewards of our healthcare dollars,” Lee Fleisher, MD, retired chair of the ASA Committee on Performance and Outcome Measures, toldMedscape Medical News when asked why the society decided to participate in the ABIM campaign. The program began in April 2012.

“This whole campaign is about saying ‘Maybe we [physicians] shouldn’t be doing some things we’ve always done,’ ” said Dr. Fleisher, from the University of Pennsylvania School of Medicine in Pennsylvania.

ASA leaders approved the following list of things physicians and patients should question:

1.     “Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) 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 known cardiac disease (e.g., [coronary artery disease], valvular disease) undergoing low or moderate risk non-cardiac surgery.

3.     Don’t use pulmonary artery catheters…routinely for cardiac surgery in patients with a low risk of hemodynamic complications (especially with the concomitant use of alternative diagnostic tools…).

4.     Don’t administer packed red blood cells…in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.

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

Dr. Fleisher stressed that the suggestions were not standards or class 3 recommendations from a clinical practice guideline but, rather, suggestions aimed at reducing overuse of tests and procedures. However, he noted that the Anesthesia Quality Institute, a large anesthesia registry in the United States, might evaluate whether changes in clinical practice result from implementation of the ASA advisories.

Implementation of the list will require a multidisciplinary healthcare team. Dr. Fleisher said, “These are issues that anesthesiologists should question and have discussions about with the surgeons, internists, and others who care for patients.”

Some of these recommendations overlap with those of other medical societies that have already released Choosing Wisely lists. For instance, the second suggestion is similar to the recommendation by the Society of Thoracic Surgeons (STS) against routine preoperative cardiac stress testing in patients without a history of cardiac disease who are undergoing noncardiac thoracic surgery.

When asked to comment on the ASA’s choices for its list, STS President Douglas Wood said he agrees with them. In particular, the second and third advisories pertaining to cardiac tests and procedures are “very appropriate,” said Dr. Wood, a cardiothoracic surgeon in Seattle, Washington, who was not involved with developing the ASA list.

Dr. Wood said the recommendation to not obtain baseline cardiac stress testing in asymptomatic stable patients could affect many patients.

“More often this testing results in abnormal findings that are not relevant and results in other testing and workup that may be invasive, such as cardiac catheterization, which has risks to the patient,” he said.

The ASA chose its 5 recommendations through a review of the anesthesiology literature and practice guidelines, a survey of academic and private sector anesthesiologists, and finally a review by ASA committee and section leaders.

Dr. Fleisher said he expects that there will not be uniform agreement regarding all the suggestions. “It’s a starting place for discussion,” he said.

More than 50 specialty societies have contributed lists to Choosing Wisely, according to the ABIM Foundation.