Q: Pre-Op Anesthesia Assessment

Hi. Would love to hear your process for anesthesia involvement in the pre-anesthesia assessment. We are a small OR and the RNs in the department all do a pre-op interview in person with scheduled surgery patients. They run any medical history issues by the CRNA on for the day based on our anesthesia testing protocols. But, that is really the only anesthesia involvement until the day of surgery when they review the chart and consent the patient. Do your anesthesia providers speak with the patient sometime in the days prior to surgery?

A: Our anesthesia providers do a chart review several days in advance and sometimes will call the patient or PCP regarding medical concerns. Any patient with a history of medical/anesthesia issues has a consult from the referring physician to have a pre-op anesthesia visit to hopefully avoid day of surgery delays. Our pre-op testing nurses also screen for concerns when they do their assessment a week prior and communicate with anesthesia. All inpatients are seen when scheduled for surgery.

A: We run the same way. We do not have anesthesiologists. Our CRNAs see the charts before surgery and the patient the morning of.

A: We are a small OR as well. We have a PAT Department with one full-time RN, a full-time secretary and a per diem RN. Our process is basically the same. We have PAs who review the charts as well as the charge nurse in same-day surgery to look and identify any issues as well as ask that the charts be delivered seven days out. (That seldom happens). If any issues are identified the PA or charge nurse, based on protocols, will contact anesthesia who then will attempt to solve things before the patient arrives. However, we still end up with some cancellations. We are currently looking at a few electronic solutions for PAT that will automatically triage the patient based off the software. We are just not big enough to have a full-time anesthesia provider in PAT all day.

Q: Being on the Other Side

Recently I was a patient undergoing surgery in the facility where I work. I was not nervous in the least. It was somewhat surreal. I was surrounded by all my co-workers. I felt at ease. Everything went great. It was eye opening to be on the other side and see and hear things that I was unable to hear and see from a staff person’s point of view. It has re-energized my commitment to excellent nursing care. I am blessed to be surrounded by such caring and competent individuals. It is not a bad idea to occasionally be on the other side. I have always wanted to implement an annual competency, if you will, that would require staff to undergo a mock procedure. Just being pushed around on a stretcher in only a cotton gown and being the only one in the suite without a mask is quite a humbling experience.

A: Wonderful that you are able to say this about your facility and team.

A: When on the other side, the level of vulnerability you feel is humbling. Everyone in perioperative service areas should experience it.

Q: Endoscopy Patients

I am wondering if anyone has answers regarding the very small population that absolutely has no ride home. They have arranged for medical transport buses but these do not provide any personnel who would respond if the patient had an emergency. It is a glorified taxi service. We feel bad when we have to cancel these folks but the rules are clear. Our only option is to admit them as a 23-hour but that is not financially feasible.

A: We’ve kept some of these patients a little longer and then arrange for the transport bus or taxi home. Most family members wouldn’t be able to respond to an emergency either except for calling 911 which the drivers would also do.

A: We cancel the surgery if we find out ahead of time (even that morning). If we find out afterwards (i.e. the patient’s ride “doesn’t show up”), then we recommend a transfer to the hospital for 23-hour observation. We’ve never had a patient agree to that, instead, they sign an AMA form. That probably happens once a year, typically, once we tell them we’ll have to transfer them to the hospital, they magically track down a relative or neighbor to give them a ride home and sign off on discharge papers.

A: We admit ours as a hospital convenience for 23 hours or until the next morning.

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