These are the gray areas, says Dr. Daley, the uncontrolled, unidenti-
fied clinical issue. What he'd say to the surgeon: "You're right. Maybe
there's nothing wrong with this guy. But based on his history, we're
probably better off postponing the case until after we have a cardiolo-
gy consult."
Where do you draw the line?
You're not alone if you sometimes feel pressured to accept a border-
line patient for surgery. "I think we all have," says Bonnie Bowman,
CRNA, of South Boston, Va. "As anesthesia providers, we have an obli-
gation to put patient safety first. Trust your gut feeling about a patient."
It's not always the type of surgery, but the type of anesthesia that's
the bigger concern. "The surgery can sometimes be the easiest phase,"
says Ms. Bowman. "But an ASC is not prepared or equipped to deal
with all of the problems that can occur in borderline patients."
Anesthesia clearly calls the shots when it comes to deciding a ques-
tionable case, according to our survey. Nearly half (48.5%) of our 100
respondents say anesthesia providers have the final say on whether
you'll operate on a borderline patient. Surgeons make the call 10.1% of
the time. In 41.4% of cases, it's a collaboration.
"The decision is not made unilaterally," says Ms. Bowman. "It
involves the surgeon, the patient and family. Often the deciding factor
is post-care and the possible need for overnight hospitalization."
Does procedure type affect your decision to accept or reject a border-
line patient? "Yes, we are more likely to accept someone borderline for
a minor procedure vs. a complicated case," says Amiee Mingus, RN
CPAN, director of clinical operations at Regent Surgical Health in
Westchester, Ill. Andrea Crigger, RN, BSN, CNOR, RNFA, of Wythe
County Community Hospital in Wytheville, Va., agrees, saying you can
look at different ways to administer anesthesia that may be less stress-
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