Board advisors press for better anesthesia trend analysis; debate tracking of ‘portable’ services

Members of the board’s anesthesia-related advisory discussions spent an extended portion of the Feb. 20 meeting reviewing a staff spreadsheet summarizing complaints involving licensees who provide sedation or anesthesia.

"I like what I see here," said Doctor Robert McNeal, urging the committee to pursue trend analysis. He added that the format staff provided will make it easier to spot patterns over time. Staff members responded that a set of bar graphs and annualized summaries could help the committee identify whether adverse outcomes were clustered by anesthesia modality (local anesthetic, nitrous oxide, moderate sedation, general anesthesia) or by practice context.

Committee members also questioned a spreadsheet field labeled "portability." Doctor Brian Henderson and others asked whether that column correctly indicates that a sedation provider was delivering care in multiple locations ("portable services") at the time of an incident. Agency staff explained that an explicit portability rule or application field was removed from board rules years ago, but that the current online application and renewals still include a question asking whether a licensee provides anesthesia services in multiple locations; that answer is stored in the licensing system (Versa/PaperVision). Dan (agency staff) said he filtered the dataset to remove events that were not anesthesia-related and that, "the ones that are on there... anesthesia was involved," but acknowledged the report cannot always answer whether the anesthesia caused or merely coincided with a complaint.

Several board clinical members focused on the high number of events coded as involving local anesthetic. "It would be nice to probably know what's causing it — is it a local anesthetic toxicity that's becoming the biggest issue?" asked Doctor Morehead. Doctor Bell noted that the Dental Anesthesia Advisory Committee performs deeper case reviews and makes annual recommendations to the board; she described their process for close case review and for follow-up with PRN when substance misuse is involved.

Staff and clinicians agreed the dataset is currently too small to draw statistically significant conclusions from two quarters of data. Multiple clinicians urged that the agency refine how the data are captured — for example, adding a field to distinguish whether an event was anesthesia-related and specifying the anesthesia modality. They also suggested annualized charts and an ability to drill down into individual cases when the spreadsheet flagged an anesthesia concern.

The committee did not enact a rule in this session but directed staff to consider better visualization and data collection for future reporting to the anesthesia advisory committee and the board.