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Improving Patient-Centered Care Delivery in 2017: Introducing Pre-Anesthesia Decision Aids
Introduction/Problem
Results/Progress to Date
Shared decision making is a patient-centered method of making medical
decisions that requires physicians to engage with patients regarding treatments
that have options – options for which patient preferences as well as physician
professional opinion warrant consideration prior to making a final treatment
decision. Shared decision making is most appropriate when there is more than
one clinically appropriate approach to treatment without complete consensus
amongst medical professionals, which is a commonly encountered scenario in
anesthesia. In such a situation, decision aids can help patients understand the
different therapeutic options and the clinical evidence for each and can assist
them in forming and conveying their preferences to their physicians.
Aim/Goal
To develop anesthesia decision aids to enhance patient knowledge about
anesthetic techniques and improve patient engagement in making anesthesiarelated decisions.
The Team
Karen Domino, MD, MPH – University of Washington Department of
Anesthesiology & Pain Medicine
Karen Posner, PhD – University of Washington Department of
Anesthesiology & Pain Medicine
Lindsay Sween, MD, MPH – CA1 Resident, BIDMC Department of
Anesthesiology, Critical Care and Pain Medicine
Fred Shapiro, DO – BIDMC Department of Anesthesiology, Critical Care
and Pain Medicine
The Interventions
In 2010, the ASA Committee on Professional Liability partnered with the
shared decision-making team at the University of Washington under a grant
from the Agency for Healthcare Research and Quality (AHRQ R21 HS19532)
to develop regional anesthesia decision aids.
Two patient decision aids were developed: Epidural and Spinal Anesthesia
and Peripheral Nerve Blocks. They describe the nature of the procedure,
benefits, risks (minor and major), side effects, choices, and a reference list.
Spaces are included for patients to list the benefits that matter most to them,
concerns about possible risks, questions, and information needs.
The decision aids were transitioned to the ASA Committee on Patient Safety
and Education (CPSE) for branding and were approved by the ASA
Administrative Council on December 9, 2016 for use in anesthesia clinical
practice.
Snapshot of the first page of the Epidural and Spinal Anesthesia and
Peripheral Nerve Block patient decision aids.
Lessons Learned
The Epidural and Spinal Anesthesia and Peripheral Nerve Block decision
aids were tested with patients in a pre-anesthesia evaluation clinic. They
were shown to increase patients’ knowledge about regional anesthesia and
engagement during the clinic visit. Patients more frequently discussed their
anesthesia options during the clinic visit if they had been given a decision
aid before their visit compared to patients who did not receive decision aids.
Next Steps
Currently, ASA governance, publications, and digital content staff are
working to copyedit and post the pre-anesthesia patient education decision
aids online to be readily available to ASA members for adoption into
anesthesia practice.
The CPSE proposes the development of additional patient decision aids.
For the next decision aid, we might consider the term “Twilight Sleep",
clarifying what this means to the patient and how this may differ from the
term “sedation”. Our goal will be to help patients understand the types of
procedures in which these anesthetic techniques might be used, their level
of consciousness during the procedure, and what they can expect to feel
using such a technique.
Other possible future decision aids include DNR/DNI orders during the
perioperative period, Monitored Anesthesia Care (MAC), and herbal
medications, including medical marijuana.
For more information, contact:
Fred Shapiro, DO; BIDMC Department of Anesthesiology,
Critical Care and Pain Medicine; fshapiro@bidmc.harvard.edu
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Fred Shapiro (<a href="mailto:fshapiro@bidmc.harvard.edu">fshapiro@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Location or Affiliate
BIDMC
Project Team
Karen Domino
Karen Posner
Lindsay Sween
Fred Shapiro
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving Patient-Centered Care Delivery in 2017: Introducing Pre-Anesthesia Decision Aids
Date
A point or period of time associated with an event in the lifecycle of the resource
2017
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Equality
Patient and Family-Centeredness
Safety