Anesthesiology
September 22, 2026 · via Europe PMC
Effect of In-line Clinical Decision Support to Improve Accuracy of American Society of Anesthesiologists Physical Status Documentation: A Two Center Evaluation of a Quality Intervention.
Murphy ZR, Colquhoun DA, Mentz GB, +6 more, Klumpner TT
AI summary — for doctors, generated from the abstract only
An in-line clinical decision support tool increased the proportion of patients assigned ASA physical status 3 or higher.
What was studied
A two-center quality improvement evaluation using difference-in-differences, comparing ASA PS assignment before and after CDS implementation at one academic center (251,944 anesthetics) against a contemporaneous control center (286,172).
Key findings
- ASA PS 3 or higher rose from 52.9% to 61.7% at the intervention site (aOR 1.42)
- Control site rose slightly from 47.2% to 48.4% (aOR 1.05)
- Among patients with targeted conditions, ASA 3+ rose from 83.6% to 94.0% (aOR 3.54)
Clinical relevance
CDS can improve consistency of ASA PS documentation, with implications for risk adjustment and billing, though accuracy against a gold standard was not assessed.
Who should care
Limitations
Observational before-after design; increased classification is assumed but not proven to reflect greater accuracy.
Real-time prompts led anesthesiologists to assign higher ASA classes when warranted conditions were documented.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
American Society of Anesthesiologists Physical Status (ASA PS) classification is a widely used ordinal scale that captures comorbidity burden but has significant inter-rater variability. Previous efforts to enhance ASA PS documentation with Clinical Decision Support (CDS) are limited by inaccurate problem lists, poor user experience, or consideration of select comorbidities. We developed and implemented a CDS which uses the anesthesia clinicians' documentation to highlight potential under-classification at time of ASA PS assignment.
METHODS
Building upon examples from ASA Committee on Economics and institutional consensus, we identified 51 conditions warranting an ASA PS of at least 3. This was embedded in CDS and implemented at our large academic medical center (Site 1). We compared the percentage of patients assigned an ASA PS 3 or greater before (May 22, 2023 to May 22, 2024) and after complete implementation (August 14, 2024 to August 14, 2025). A second large midwestern academic medical center served as a contemporaneous external control (Site 2). Using a difference in difference analysis, we constructed odds ratios for assignment of ASA PS 3 in all patients and selected sub-populations.
RESULTS
The study included 251,944 anesthetics from Site 1 and 286,172 from Site 2. Baseline characteristics were similar between sites. At Site 1, the proportion of patients classified as ASA PS 3 or higher increased from 52.9% to 61.7% (aOR 1.42, 95% CI 1.38-1.45). Site 2 experienced a small absolute increase from 47.2% to 48.4% (aOR 1.05, 95% CI 1.03-1.07). Among patients at Site 1 with 50 conditions addressed by the latter phase of the CDS, the proportion classified as ASA PS 3 or greater increased from 83.6% to 94.0% (aOR 3.54, 95% CI 3.34-3.76).
CONCLUSIONS
Implementation of our in-line real-time CDS was associated with a significant increase in the percentage of patients with ASA PS 3 or greater.
DOI
10.1097/ALN.0000000000006388
PMID
42770562
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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