History & Physical

  • A current pertinent history and physical exam (H+P) is required within 30 days of surgery or procedure.
  • Guidelines for the required content of the H+P is derived from the Medicare Guidelines for ASCs.
  • The H+P can be completed in the office as part of the initial work-up and faxed to the facility, or the surgeon may elect to complete it the day of surgery.
  • If the patient’s medical history is complex or if the insurance company requires, the surgeon may elect to send the patient to their primary care giver.
  • The H+P must be on the chart prior to surgery.

Anesthesia Review

  • Those patients whose pre-admission assessment reveals any medical abnormalities, will have their medial record reviewed by an anesthesia provider before the day of surgery/procedure.
  • If a patient has an extensive medical history, the surgeon may elect to call the ASC for an anesthesia consultation.
  • The ASC has no upper age limit and most ambulatory patients are acceptable candidates for outpatient procedures (exception might include a limited procedure for the patient with a significant systemic illness).

NPO Guidelines

For the purpose of increasing compliance and ease of instructions:

Adults and older children (age > 9):

  • NPO 6 hours for non-greasy solid foods
  • NPO for at least 4 hours for non-clear liquids

Children (ages 1through 8):

  • NPO > 6 hours for non-greasy solid foods
  • NPO > 4 hours for clear liquids.

Infants (ages 3 months to 1year):

  • NPO > 6 hours for formula.
  • NPO > 5 hours for solids
  • NPO > 4 hours for breast milk
  • NPO > 2 hours for clear liquids

Definition of clear liquids:

  • Water
  • Clear apple juice
  • Gatorade

Note: There may be unique situations (ex: afternoon surgery) whereby the NPO guidelines will be altered based on the surgical situation and the anesthesiologist’s assessment and approval.   This will be discussed when the ASC calls the patient pre-operatively.

Medications

  • Medications may be taken the morning of surgery with a sip of water unless otherwise directed by the surgeon or anesthesiologist.
  • Diabetics will be instructed individually based on the insulin/oral hypoglycemic need, history of glucose control, pre-operative glucose level, and the scheduled time of surgery/procedure.

Pre-Admission Testing Requirements

  • The following is only intended as a guide in preparing patients for surgery.
  • The ASC may exercise flexibility in requiring more or less testing after assessing the patient.
  • The ASC realizes that unnecessary testing may lead to cancellations of needed surgery
  • and added inconvenience and expense, based merely on a false positive or erroneous result.
  • The patient’s medical history is used as guide for testing above and beyond the standard screening tests.

Guidelines

< 50 and otherwise healthy – No testing required

EKG:

  • > 50 and otherwise healthy – EKG within 6 months
  • History of significant cardiac disease or diabetes treated with medication: EKG within one month

Labs:

Electrolytes within one month (SMA-7: Glucose, Na+, K-, BUN, CR, chem panel):

  • Diabetes treated with medication (finger stick glucose will be performed on admission).
  • History of significant endocrine disease (uncontrolled thyroid disease, history of adrenal disease)
  • History of severe renal disease (for patients requiring dialysis – results of electrolytes after last treatment)

Complete Blood Count (CBC) within one month:

  • History of significant anemia, recent bleeding, blood disorder, history of bleeding disorder or on anti­  coagulant   therapy  (i.e., Coumadin: include PT/PTT with the CBC)
  • For surgery with potential for significant blood loss, a hemoglobin may be done the day of surgery/procedure at the ASC.

Liver Function Tests

  • History of active or severe Liver dysfunction

Chest X-Ray

  • Rarely required.
  • Helpful in patients with debilitating, unstable or new onset respiratory condition per the discretion of attending anesthesia team

Pregnancy Test

  • A urine pregnancy test is performed on all women of child bearing years.
  • However, any woman who is confident she could not be pregnant and signs a form which states that she understands the risks of elective surgery and anesthesia to the fetus may refuse the test.