Pre-anesthesia testing (PAT) clinics provide comprehensive patient assessment to help identify potential anesthesia risks that can negatively impact surgical outcomes.  According to Davenport [1], each year, more than 200 million people undergo surgery worldwide, and in the United States population has become increasingly complex with multiple medical comorbidities and polypharmacy.  In fact, Davenport et al (2005) describes that 26% of all inpatient adverse events in elderly population are associated with surgery and 44% of adverse events are preventable.

Advanced practice providers (APPs), global term for Nurse Practitioners, Physician Assistants and Certified Nurse Anesthetist, have an emerging role in the PAT clinics helping bridge the gap between primary care and specialty care through care coordination, comprehensive assessments, and patient education.  These activities ensure that patients are at their best possible health reducing the risk of post op adverse events or complications and overall hospital costs.

Care coordination can be time-consuming.  However, nurse practitioners work closely with members of the healthcare team coordinating and expediting patient care to avoid surgical delays or undue cancellations.  For example, on PAT physical assessment, I noticed an enlarged goiter on a patient scheduled for oral cancer surgery. The goiter was deviating the trachea, which represents a significant airway risk potentially leading to difficult intubation. Immediately, I spoke with the attending anesthesiologist and we both agreed patient needed an urgent ENT consult and CT of the neck before surgery. I was able to order the CT of neck, contacted radiology department and patient had it done the next day.  Meanwhile, I coordinated ENT consult within days and patient was cleared to go for lifesaving cancer surgery without delay. 

Besides care coordination, APPs conduct comprehensive assessments to identify potential health risks improving patient surgical outcomes. Patients who come to the PAT clinic are given a comprehensive assessment including a health review, physical exam, and preoperative instruction and education of how to prepare for surgery.  If any issues identified, collaborate with members of the healthcare team including anesthesiologists, cardiologists, primary care physicians and interdisciplinary teams within radiology and lab departments to optimize patients for surgery.

An important role of APPs in the PAT clinic is patient education. Providing patients with the information they need to manage any unexpected circumstances such as trouble with transportation or what to expect before and after surgery as far as where to go and what to do can significantly allay patients’ fears and anxiety associated with surgery.  Also, APPs reinforce important medical information such as instructions on medications to take or hold before surgery, to monitor their blood pressure and blood sugar preop to ensure optimal hypertension and diabetes control to reduce health risks.   Well informed patients translate into increased patient’s compliance and less last-minute surgical delays and cancellations that can negatively impact the economy of the operating room including hospital costs. Research has demonstrated that reducing the risk of intra and post operative complications results in significant hospital cost savings [1].

In summary, APPs have a unique role in the PAT clinic.  They are actively involved in patient care coordination among members of the health care team. Patient optimization is associated with a lower risk for adverse surgical outcomes as well as the probability that a procedure will be delayed or postponed, decreasing hospital costs.  Also, they perform comprehensive assessments of patients and prevent unnecessary investigations and consultations that can potentially delay or cancel surgeries.  They educate patients about the perioperative process and answer questions to promote patient compliance. Overall, APPs contributions in PAT clinics are associated with best patient outcomes, lower rate of surgical cancellations and delays plus hospital costs savings.  

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[1] Davenport, D. L., Henderson, W. G., Khuri, S. F., & Mentzer, R. M., Jr.   (2005). Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: A case study using the National Surgical Quality Improvement Program (NSQIP) database. Annals of Surgery, 242, 463–71.