Following guidelines when scheduling patients and completing procedures should be kept in mind to ensure your day goes smoothly. The patients’ anesthesiologist will discuss the anesthetic plan with you in advance. They will address any safety measures needed. You will work as a team to devise a plan that offers the patient the best care possible.
Surgery Guidelines
Schedule Surgery
1 month prior to procedureRequest Day(s)
Send an email or text with your desired day(s). We will check and see if the day is available. If it’s not available, we will offer you and alternate date. It helps to know if you prefer a specific day of the week.
Upload Patient Documents
1 week prior to procedureEgnyte
Schedule patients and upload their documents with the provided “Prior Auth” cover sheet. The patient documents should be uploaded to a folder labeled with the date of the scheduled procedures. A provider will review the documents for medical history and insurance prior authorization.
Confirmation
2 days prior to procedureConfirm Appointments
Call all scheduled patients to confirm the appointment. Make sure they have all anesthesia instructions, including NPO guidelines. Inquire if the patient has any acute medical issues, such as infection or wheezing. Replace any patient with medical issues or that cannot confirm their appointment if needed.
Pre-operative Interview
Procedure dayEvaluate Health and Compliance
The anesthesiologist will review the patient’s medical record and interview the patient. They will evaluate the patient for acute or chronic conditions that puts the patient at risk for complications. They will also ensure the patient has complied with NPO guidelines. A plan will be developed to decrease the risk. The patient may be rescheduled to optimize the patient’s condition to prevent serious complications.
Procedure
Anesthesia Start
If the patient is okay for anesthesia and the procedure, the anesthesia will start the anesthetic. A relaxant is usually given first for the patient’s comfort. The anesthesiologist will let the provider performing the procedure know when the patient is ready for the procedure. The anesthesiologist will monitor the patient’s vitals and medial status throughout the procedure. They will treat any abnormalities that may arise.
Recovery
Procedure dayMonitor Patient
The anesthesiologist will transport the patient to recovery when the procedure is complete. Recovery staff will monitor the patient’s vitals and medial status in recovery under the supervision of the anesthesiologist.
Discharge
Procedure dayInstructions and Dismissal
The recovery staff will inform the anesthesiologist when they feel the patient is ready for discharge. The anesthesiologist will check the patient personally to ensure discharge is adequate. If so, the patient will be given discharge instructions and sent home.
Post-Operative Follow-Up
Procedure dayCall Patient
The staff will call the patient within 24 hours of the procedure to follow-up with the patient for any signs of complications from the procedure or anesthesia. Follow-up calls should be documented in the patient’s medical record.
Common Reasons for Cancellation
The most common cause of procedure delays and cancellations we have is noncompliance with NPO guidelines. Many patients are unaware of the dangers of having a procedure without an empty stomach.
Pulmonary aspiration of gastric contents is a feared but largely preventable complication of anesthesia. Half of aspiration-related claims involved emergency surgery. For non-emergent surgeries, patients are asked to fast in order to allow for sufficient gastric emptying time to prevent aspiration. The 2011 evidence-based ASA guidelines for fasting time are as follows:
Clear Liquids: 2 hours
Breast Milk: 4 hours
Other Milk: 6 hours
Light Meal: 6 hours
Heavy Meal: 8 hours
Some medical/patient conditions may alter the amount of time for food to clear the patients stomach. In these cases, the anesthesiologist may extend the NPO guidelines.
It is important to get a full medical history prior to the day of the procedure. If the patient has any active medical conditions or sees a medical specialist, contact the anesthesiologist. The patient may need further work-up or medical records in order to proceed with the procedure. The patient may have to be rescheduled if it is not completed in advance.
The most common, unavoidable cancellation is due to acute medical conditions, such as an active respiratory or other infection or wheezing due to asthma . The patient will be rescheduled to a later date when proceeding with anesthesia will be safe.