S104 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 76 • SUPPLEMENT 4 NOVEMBER 2009 ABSTRACT Q Three directors of dedicated preoperative assessment clinics share their experience in setting up and running their programs. Standardizing and centralizing all or part of the preoperative evaluation process—obtaining patient records; the history and physical examination; the surgical, anesthesiology, and nursing assessments; ordering tests; and documentation and billing—increases efficiency. The savings achieved from minimizing redun- dancy, avoiding surgery delays and cancellations, and improved reimbursement coding offset the increased costs of setting up and running the clinic. KEY POINTS Q Standardizing the preoperative assessment process helps ensure that regulatory, accreditation, and payer require- ments and guidelines are met. Careful triage based on a patient’s history can help avoid unnecessary assessment of low-risk patients and ensure that necessary assessments for higher-risk patients are completed before the day of surgery. Perioperative assessment and management guidelines for various types of surgery and patient risk factors should be developed, continuously updated, and made available online to all providers within the institution. Electronic medical records allow standardization of patient information, avoid redundancy, and provide a database for research. Weiner Center for Preoperative Evaluation at Brigham and Women’s Hospital By Angela M. Bader, MD, MPH When organizing our preoperative clinic at Brigham and Women’s Hospital, we had several goals. Overall, we wanted a standardized process to help us achieve a high level of excellence. We hoped that creating a new system would eliminate ambiguity about who was responsible for following up on a patient’s abnormal laboratory test result—the surgeon, anesthesiologist, or primary care physician. We also wanted to better coor- dinate the various care teams involved throughout the perioperative period. STANDARDIZATION HELPS MEET MANY GOALS Q Standardization can occur at many levels: Performance of assessments and testing • Organization of the patient chart and medical records • Systems checks throughout the process to ensure • that nothing is missed Team-to-team communication. • Documentation requirements apply regardless of institutional structure When considering any system of preoperative assess- ment, keep in mind that the hospital must meet and appropriately document compliance with all regulatory, accreditation, and payer requirements and guidelines, such as those of the Joint Commission, the Centers for Medicare and Medicaid Services (CMS), and the National Surgical Quality Improvement Program. For example, the Joint Commission requires that a surgical history and physical examination be done within 30 days of a procedure. An anesthesiology assessment and a nursing assessment are also required. All of these assess- ments have mandatory elements, including document- ing “never events” and ordering appropriate laboratory tests, electrocardiograms (ECGs), and radiographs. Sometimes administrators of other hospitals say to me, “We can’t afford a preoperative clinic, and we don’t need one.” My response is that regardless of whether a hospital has a preoperative clinic, the regulatory require- ments and guidelines must be met: it is not an issue of ANGELA M. BADER, MD, MPH Director, Weiner Center for Preoperative Evaluation, Brigham and Women’s Hospital; and Associate Professor of Anaesthesia, Harvard Medical School; Boston, MA Nuts and bolts of preoperative clinics: The view from three institutions See end of article for author disclosures. doi:10.3949/ccjm.76.s4.17 BOBBIEJEAN SWEITZER, MD Director, Anesthesia Perioperative Medicine Clinic; Associate Professor of Medicine; and Associate Professor of Anesthesia and Critical Care, University of Chicago, Chicago, IL AJAY KUMAR, MD Director, IMPACT Center, Department of Hospital Medicine, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, OH on June 8, 2022. For personal use only. All other uses require permission. www.ccjm.org Downloaded from