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Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic
  1. Alexander B Stone1,2,
  2. Andrés Zorrilla Vaca1,2,
  3. Philipp Lirk1,2,
  4. Philipp Gerner2,3 and
  5. Kamen Vlassakov1,2
  1. 1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Alexander B Stone, Brigham and Women's Hospital, Boston, MA 02115, USA; abstone{at}


Introduction When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (AStart) time should include the block procedural time. We measured how often AStart time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block. We hypothesized that the involvement of a regional anesthesia team would lead to more accurate documentation of AStart. We also estimated the lost revenue due to inaccurate start time documentation.

Methods The study population were patients undergoing surgery with a peripheral nerve block as the primary anesthetic. For this analysis, AStart occurring less than 10 min before the in-operating room time was defined as potentially inaccurate. Lost potential revenue was estimated by taking the difference between the documented time of local anesthetic administration and the documented AStart time.

Results A total of 745 cases were analyzed. Overall, 439 cases (58%) cases were identified as having potentially inaccurate start times. There were higher rates of inaccurate AStart documentation by the block team (316/482, 65.5%) compared with blocks supervised by the in-room anesthesia attendings (123/263, 46.7%, p<0.001). Overall, the estimated loss in billable revenue during the study period was a total of $70 265.

Conclusions The performance of primary regional anesthesia procedure by a block team increased the incidence of inaccurate documentation and uncaptured potential revenue. There is need for education about accurate nerve block documentation for anesthesiologists, especially when separate teams are used.

  • Nerve Block
  • Economics
  • Acute Pain

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  • Contributors All authors were involved in study design/planning, data analysis, interpretation of results, preparation of paper, and review of paper. ABS serves as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ABS and KV are associate editors of Regional Anesthesia & Pain Medicine. PL is associate editor of Anesthesiology.

  • Provenance and peer review Commissioned; externally peer reviewed.