Page 30 - 2022 Risk Basics - Anesthesiology

SVMIC Risk Basics: Anesthesiology

State law and with facility policy. The evaluation is performed
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and documented by a practitioner qualified to administer
anesthesia only after the patient is sufficiently recovered from

the effects of anesthesia (e.g., able to answer questions) in the

PACU/ICU or in another designated recovery location.

Regarding claims arising out of the PACU, one of the elements

frequently found missing in the claims review was patient

status at handoff to PACU nurses. There should be a
systematic handoff of anesthesia care between anesthesia

providers and nurses in PACU. The ASA Standard is that a

member of the anesthesia team accompanies the patient to
the PACU, and upon arrival in the PACU, reevaluate the

patient and give a verbal report to the responsible PACU
nurse. This should be documented with times and with

oxygenation status. The Anesthesia Quality Institute has
handoff criteria available for transfer of care from the

procedure room to the ICU and also to PACU.
14

The other main element missing in the documentation was
determination of patient status prior to discharge. Discharge of

the patient too early and without oversight by the

anesthesiologist are common allegations. There should be
assessment criteria used by PACU nurses that have been

developed and approved by the Anesthesia Department.

Anesthesia needs to see the patient and agree that it is the
appropriate time for discharge and this decision needs to be

properly documented. In cases where the patient is advised to

13 https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Hospitals.html
14 https://www.asahq.org/standards-and-guidelines/standards-for-postanesthesia-care

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