The ASA PS Classification System (Nov 15 PAAD)
It would be interesting to compare the ASA classification of the same patients in the UK where the National Health Service pays its doctors with a salary regardless of the patient physical status or an emergency operation, and Canada where there is an additional financial "bonus" for ASA 3 and above and the E code only kicks in for an ASA 3 and above. I don't know what happens in the USA.
I have worked in both systems. An uncomplicated patient with T21 gets ASA 2 in the UK and ASA 3 in Canada.
What about patients for emergency appendectomy? I still classify the afebrile "grumbling" appendix as ASA 2 E but if the patient is septic and systemically unwell, they become ASA 3. Few of my colleagues do the same. They classify those grumbling patients as 3 minimum (two bonuses) or 4 (large bonus+ small bonus) if they are septic. My residents and surgeons sometimes comment on my lower ASA status grading or on unjustified high grades by some colleagues at large. I am not a saint; I am trying to be rigorous.
In my 10 years of practice in Canada I only ever classified one (pediatric) patient as ASA 5. He was moribund, and I am pleased to say that he made a full recovery.
Carine
Dr Carine Wood,
Associate Professor,
Dept. of Anesthesia,
HHS and McMaster University,
WOW, I didn't know that you could get a bonus based on the ASA classification!