Just following your policy
Remember, anesthesia's role is to quickly review the information, assess
the patient and determine if the patient is a safe candidate for surgery.
Take, for example, a patient who has obstructive sleep apnea (OSA).
Your policy states that you'll cancel the case if an OSA patient doesn't
have her CPAP with her. The anesthesia provider might feel he can safe-
ly care for the patient with a multimodal approach, but your unyielding
policy doesn't support this practice.
What about white blood cell counts that are too high? This might
also be grounds for cancellation, per your policy. But if the patient is
asymptomatic, doesn't have a shift, and the surgeon and anesthesia are
aligned, the case could move forward, right? Not unless anesthesia
wants to violate your policy. Asking a provider to "make an exception"
or "bend the rules" often puts him in an untenable situation from a
legal and practice standpoint.
Then there's incorrect or incomplete health information. With more
insurers denying medical testing, many patients don't have complete
health information. Ever hear a patient say, "That pain in my chest
ain't nothing more than a little heartburn" when in fact the patient
has a heart history and hasn't been worked up in 5 years? Or perhaps
you have one of those "healthy patients" who "never needs to go to a
doctor." But in pre-op, anesthesia notes a blood pressure of 220/110 or
a previously undiagnosed irregular heartbeat.
Many say having anesthesia and surgery is the ultimate stress test
for patients. Those with previously untreated or undiagnosed medical
conditions might be at risk for complications during or after surgery if
they're not treated before surgery. Anesthesia might feel that the
patient is safe for surgery, but fear complications after surgery.
Delaying the surgery to tune up the patient could be the best decision.
If you delay or cancel a patient, provide clear next steps, schedule
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