— and where — to operate on a borderline
patient.
"The convenience of the surgeon does not
take priority over the safety of the patient,"
says anesthesiologist Vince Kasper, MD, the
director of regional anesthesia at United
Anesthesia Services in the Philadelphia area.
"Safety should always win over convenience and
cost."
Still, there are pressures to fill the surgical
schedule, which can put the surgeon, anesthe-
sia provider and administrator in the uneasy
situation of having to accept or reject a bor-
derline patient for surgery. As Marc Chudow,
RN, charge nurse at the University of South
Florida Morsani ASC in Tampa, Fla., says, "We
are always trying to build volume. You don't
get paid if you don't work."
Certain factors could instantly disqualify a
patient from same-day surgery. An
Outpatient Surgery Magazine survey of 100
surgical facility leaders listed difficult airway,
obesity, history of heart trouble, sleep apnea
and diabetes among them. But these are not
hard-and-fast rules. "We do all of the above
patients if they have cardiac clearance or are
otherwise controlled and managed appropri-
ately by their primary care doctor," says
Carol Wenzel, RN, the director of nursing at
the Kenwood Surgery Center in Cincinnati,
5 2
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