Surgicenter Pre-Op Call

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Pre-Operative Interview

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No
Surgeon's Name has no list assigned

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EKG and Labs Policies

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Age > 65

• Cardiovascular disease includes anyone with congenital heart disease, COPD, coronary or valvular heart disease, hypertension, arrhythmia, history of heart failure, or pacemaker / AICD. The EKG is valid for 3 months for these patients unless there is a change in their medical condition 

• In patients who are > 50 years old without cardiovascular disease the EKG is valid for 6 months unless there is a change in their medical condition 

• Thoracic/major vascular procedure need an EKG

Chest X-ray

• None based on age 

• Not indicated unless warranted by patient’s clinical condition (pneumonia, pulmonary edema, mediastinal mass)

CBC (Hct, platelet count)

• History of anemia 

• Procedure with anticipated significant blood loss, greater than > 5% of estimated blood volume 

• History of bleeding disorder (myeloproliferative disease, sickle cell disease) 

• Patients having spinal or epidural anesthesia.

Glucose

• Diabetes mellitus or risk factors/symptoms (obesity, polyuria, polydipsia)

Serum electrolytes

• Diabetes mellitus and other endocrine disorders, renal disease, hepatic disorders 

• Post dialysis patients 

• Medications affecting or affected by electrolytes, (diuretics, digoxin) BMP is good for 6 months.

Liver function tests

• Cirrhosis or history of liver disease Coagulation tests

Coagulation tests (PT/PTT)

• History of bleeding disorder, liver disease, or malnutrition 

• Patients on anticoagulants (warfarin, heparin)

Pregnancy test 

• Required for all women of menstrual age, except those who had a hysterectomy, tubal ligation, or menopause (passage of at least one year without menses at age 45 or older) Pregnancy test is good for 7 days.

No

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Attach Scan or Picture of EKG
No

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Attach lab results here with a picture or scan
No

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Attach H&P if Applicable

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Pre-Operative Instructions

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Verbalizes Understanding of NPO Instructions has no list assigned
Verbalizes understanding of Medication Instructions has no list assigned
Verbalizes understanding of What to Bring and What Not to Bring has no list assigned
Verbalizes understanding of Personal Care has no list assigned
Verbalizes understanding of Post-Op Pain Control has no list assigned
Verbalizes understanding of Discharge Planning has no list assigned