Concepts relating to "Anesthesia for patients with varying degrees of pre-existing disease"

I think that these essentially are based on the ASA 1/2/3/5/4 definitions (the mapping is very close), and exploit them to describe procedures rather than as descriptions of patient status. I've had a quick look at Anesthesia SIG minutes from 2014 and I haven't easily found a discussion of this issue although I have a feeling that it has been mentioned (susequent to the ASA classification update in 2014). Perhaps another SIG/ CRG member will recall...

Specifically:

1. ASA classification is in widespread UK/ US/ International use for clinical and academic purposes. It is a useful shorthand when I want to express how "unwell" an individual patient is.
2. I can't speak for the SNOMED terms, as a clinician I haven't specifically encountered their use. They are perhaps, however, more suited to administrative than clinical use. There is no specific anesthetic technique which distinguishes the categories.

Regards,

Andrew.

The assessment findings of ASA status would be appropriate to record in shorthand, however the current procedures might lead to an apparent multiple anaesthetics being recorded.  In fact only the last of the concept types is arguably the appropriate procedure to be recorded. 

• Anaesthesia for (ASA status)
• Anaesthesia for (surgical procedure) - due to be retire/moved, I believe
• 50697003 | General anesthesia (procedure) | 

If they have to be retained they should be fully modelled or risk inadequate equivalence detection.

Of course the other element is the ambiguity of type of anaesthesia general/local/regional etc

It would be helpful if a standard for anaesthesia practice was collaborated between SI, HL7, professional bodies in a similar way to the International Patient Summary.  This might give better carity of how the record is meant to be constructed.

Paul,

Apologies for my slow reply - have been away at BMA annual meeting then on holiday. 

I think that these "Anesthesia for patient with xxxx systemic disease" originate from the CPT coding system (developed by the American Medical Association and used principally for reimbursement procedural coding in the USA.)  I'm not sure if CPT is used in any other country.

I think that it is far better to record the relevant ASA physical class finding term from SNOMED in a patient record and agree entirely with the points made by Andrew Marchant

So in answer to your specific questions:

1) ASA physical status classification is an internationally widely accepted and used system of broadly classifying patient comorbidity

2) I would be pretty sure that the compound " Anesthesia for patient with xxxx systemic disease" terms would only have a use in the USA

Best wishes

Andrew

Hi All, Andrew Nortonand Andrew Marchant

The consensus appears to suggest that we should inactivate the 5 concepts above as they are not useful clinically and we could also return them to the US edition.

Therefore at your next meeting, please could I ask that the group agree to make a decision on the following:

1. The following should be inactivated from SNOMED International:

• 67902001 |Anesthesia for a normal healthy patient (procedure)|
• 23102000 |Anesthesia for a patient with mild systemic disease (procedure)|
• 22211001 |Anesthesia for a patient with severe systemic disease (procedure)|
• 112989003 |Anesthesia for a moribund patient requiring operation (procedure)|
• 71191009 |Anesthesia for a patient with severe systemic disease, life threatening (procedure)|

       2. The above concepts should be returned to the US edition of SNOMED CT YES/NO

With the answers to these questions we can then close this discussion.

Many thanks for your help.

Kind regards

Paul

Paul Amos

Paul Amos Ok to inactive in SCT International and return to the US extension. - Record the ASA status as a Finding code that already exists in SCT.