Page 18 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

Therefore, in patients who have or are suspected to have OSA,

a thorough interview of the patient and/or family members
should be conducted, inquiring as to the patient’s history of

airway difficulty, snoring, apneic episodes, etc. The responses
to the interview need to be noted. A physical exam using a

classification system such as Mallampati helps demonstrate
that a thorough airway exam was performed. The Mallampati

score needs to be documented along with any other pertinent
information relating to the airway and/or OSA. If a patient

has or is suspected to have OSA, the anesthesiologist should
coordinate with the surgeon to develop a protocol for a

perioperative management plan. The written anesthesia plan
should reflect this protocol. 6

Documentation includes not only writing/typing notes in the

record but also reviewing pertinent documentation available to
the anesthesia practitioner before beginning a procedure. These

include, but are not limited to, sleep studies, labs, medication
allergies, cardiac testing, etc. In the rush to start a procedure,

for example, the anesthesiologist may not wait for lab values
to return. Pending laboratory tests should not be ignored. For

non-emergencies, all pre-operative labs that could potentially
change your course of action should be available and read. As

discussed elsewhere, the EHR’s audit trail will reveal whether
or not existing records were accessed. Remember that all lab

and diagnostic results will be in the patient’s chart when it is
reviewed in a subsequent malpractice case. Retrospectively,

you may appear negligent if you have not reviewed all of the
information that was potentially available to you. The argument

that “my surgeon was in a hurry to start the procedure” will not
be well-received by a jury.

6 http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917935

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