Incorrectly Recorded Anesthesia Start Times Cost Medical Centers & Anesthesia Practices Significant Revenue

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ORLANDO, Fla. — Inaccurately recording the start of anesthesia care during a procedure is common and results in significant lost billing time for anesthesia practices and medical centers, suggests a study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

The anesthesia start time (AST) must be documented from a computer logged into the electronic health record (EHR), and typically occurs once the patient is in the operating room (OR). However, the anesthesiologist meets with the patient prior to their arrival in the OR and begins tasks that are vital to the procedure — such as administering pre-medication and attaching monitors — and that time typically is not recorded. Depending on the patient and procedure, adding two to five minutes to the AST when logging it would account for the preparation and transit time, researchers say.

“These seemingly minor inaccuracies of recorded AST can cost medical centers and anesthesia practices hundreds of thousands of dollars in lost revenue,” said Nicholas Volpe Jr., M.D., MBA, lead author of the study and an anesthesiology resident physician at Northwestern University McGaw Medical Center, Chicago. “We suspect most anesthesiologists are unaware that they aren’t recording AST accurately. It’s not a result of negligence, but rather reflects that workflow hasn’t been optimized for accuracy.”

For the study, the researchers analyzed 40,312 procedures involving anesthesia which occurred between November 1, 2021 and October 31, 2022 at a single academic center. In 27,771 of the cases (68.74%), AST was recorded as starting once the patient was in the OR, without factoring in the preparation time. Using the national average charge for anesthesia time, themissingtimetranslatedto $638,671.57 in lost revenueforthe year, the researchers determined.*

“Logging AST is one of the many new tasks that anesthesiologists learn when starting a new role,” said Dr. Volpe. “Transitioning from an internship to clinical anesthesia practice involves learning a significant amount of new information, and understanding the importance of an accurately recorded AST may seem like a relatively minor issue compared to important patient-care information.”

Several approaches could help address inaccurate AST documentation, including educating anesthesiologists on how to improve their AST recording practices and providing visual reminders such as signs in the OR, Dr. Volpe said. Also, an AST capture function could be built into the EHR mobile application so that AST can be noted by anesthesiologists on the way to the OR, or the EHR could automatically add two minutes to the AST log time, he said. The researchers plan to roll out some of those initiatives in the spring and determine if they are effective.

*The projected savings are theoretical and not linked to billing at the institution where the study was conducted.


Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Like ASA on Facebook, follow ASALifeline on Twitter.

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