I'm bumping this old thread to address a similar issue at our hospital GI suite. I turn to you guys to give me some direction here.
FYI, we have no CRNAs and we do all our own cases.
True to my OCD tendencies, I review charts the night before on MAC colonoscopies and ERCP patients, who often are obese ASA 4 with cardiac probs, OSA, IVDA. Because in the past none of my colleagues have asked for these GI MAC patients' medical histories and pertinent workup that we require for all OR MAC patients, I was left to my own devices in terms of calling the pt's PMDs for the latest visit note, past workup, etc. I have not asked medical clearances (or new labs unless ESRD for K and DM for FS DOS), which as we all know, are meaningless unless they state that the patient is not medically optimized for surgery/procedure.
After a few months, I got fed up with doing scutwork, so I requested the GI nurses to obtain the information the day before the procedure. I haven't delayed/cancelled a single GI case so far, as much as I hate doing endo cases. (case in point:
After Death in the GI Suite, Patient's Family Sues CRNA)
Now one GI doc filed a complaint to the hospital administrators that I am taking "procedure time" away from the nurses because a nurse was on the phone with PMD's office trying to get information for a next day patient. My chairperson agrees with me that MAC is a MAC no matter what the procedure is, and that those patients should have the same workup as OR MAC patients undergo. My colleagues gave me the "Well, it's not like it's going to change anything for such short, routine procedures."
In patients with significant comorbidities, even a 30 second procedure is anything but routine in my mind. The purpose of my preop preparation is to have sense of the patient and set a threshold for how quickly I would react should things start to go south in the procedure room.
Someone once said that failing to prepare is preparing to fail. I believe that.
Tell me if I'm being overly cautious here. From this thread, it sounds like some of the guys give the green light as long as the patient hasn't eaten anything DOS.