Preops the night before surgery

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urge

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I don't see a point to it. The only real, outcome changing, benefit to preops done before hand that I see is to order tests that take some time. Basically echo, stress test, cath and/or radiology films. Maybe perhaps a consult for weird hematology stuff.

The night before surgery is too late to get anything of importance done. No point to even bother. Sure there is all that mumbo jumbo about the patient being less anxious and what not, but does that really change the outcome? Does the patient not end up 6 feet under because my CA2 resident saw him at 8pm versus me seeing him at 7am? I have yet to be convinced of this. It's always me telling the resident how they missed critical stuff that I managed to assess in less than 10 min when it took half an hour for my resident just to find the patient.

Night preops are just a waste of residents time in my opinion.

I still remember being yelled at by a nervous attending one time when I did a preop (forced by the program) before the assignments were done (not my room). It was a morbidly obese patient going for some ENT stuff. The attending was cursing because I didn't let her know the night before that she had a morbidly obese patient. Like as if it was going to make the patient skinny the next day! What difference did it make knowing that at 8pm vs 7am?

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After awhile you realize patients come in about 10 flavors and you are prepared to deal with all 10. Our surgeons give us a heads up for the zebras, "hey nimbus, I've got this guy coming down the pike....."

And you're right, that attending was cursing because SHE was nervous. It was about her, had nothing to do with the case or the patient.

Waste of time in my opinion.
 
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night before pre-ops are less for improving patient outcomes and more for resident education.

I recall preopping patients that had obscurities like Spinal muscular atrophy, various degrees of mysathenia gravis, etc. Gives material for the resident to read about the night before and discuss with the attending.

Of course you have to be skilled at evaluating patients on the fly, but thats what being on call is for
 
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I've had a cases cancelled or my attending refused to proceed because patient was symptomatic with a URI or they didn't have proper preoperative clearance (eg cardiology clearance because they had an MI in the past years ago). Would you have proceeded anyway at your institution in these situations?
 
I've had a cases cancelled or my attending refused to proceed because patient was symptomatic with a URI or they didn't have proper preoperative clearance (eg cardiology clearance because they had an MI in the past years ago). Would you have proceeded anyway at your institution in these situations?

You proceed according to your judgement. Knowing that the patient is I'll beforehand will not change the next steps. URI will not heal magically, cobsultant will not accomplish anything of value by setting the patient at 10pm., most consultants will not even come at night.

I presume you preopped those patients the night before and the case still got cancelled, right?
 
night before pre-ops are less for improving patient outcomes and more for resident education.


I guess I cannot argue that one.

However, I can still argue that the resident's learning experience would be higher yield if those 30-40 min per preop were used to read a few pages of Miller instead.

Weird diseases can be looked up the day of surgery.
 
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I guess I cannot argue that one.

However, I can still argue that the resident's learning experience would be higher yield if those 30-40 min per preop were used to read a few pages of Miller instead.

Weird diseases can be looked up the day of surgery.

Agree with everything you have said. We do not preop patients the night before at my institution. There is no point.
 
night before pre-ops are less for improving patient outcomes and more for resident education.

I'm a resident, and I agree with this. Granted, there's not much more I hate than when I'm on call, and I have to go preop patients for cases of which I won't be a part. We have to preop inpatients for CRNA cases the following day (otherwise they may have to work past 5 pm, and we all know that isn't allowed, right?). Granted if it's around 10 pm or so before we get to the preops, we just chart review instead of waking the patient up at night, so it's a little more tolerable, but still no fun.
But the reasons residents do it is so that one day, when they are attendings, they can adequately do that 10 minute preops the attendings currently do.
(Also) But it sounds like you mean physically going to see the patients and not just chart review (which I do think chart review is probably the most important part for night-before preops), so I don't see that being quite as useful when "the resident's learning experience would be higher yield if those 30-40 min per preop were used to read a few pages of Miller instead." Then again, postponing a case the night before for further workup / optimization is probably easier (for everyone, surgeons included; workflow, OR optimization, etc.) to deal with than 10 minutes before the scheduled procedure.

TLDR: Preops are no fun for residents, chart review is important but the person doing the case can/should do that, it's part of residency so I deal with it.
 
Only two useful reasons I've found for preops on inpatients the night before:
1) AICD that needs to be shut off prior to surgery, as a call to Cardiology at 700AM for a 715AM start always results in a late in-room time.
2) Phone consents on patients that are unable to consent themselves, especially first-starts.

We only pre-op the big vascular, neuro, or cardiac cases at our program, or the patients who are in the ICU who may need consent. Anything else waits until morning of surgery, unless there's an explicit and specific consult from the surgical team the night before.
 
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I too hated doing in-house preops the night before. But there was a pattern of sloppy/inadequate/nonexistent workups done by the surgical service that added them on at 4 PM, so it was probably good that a doctor saw those patients before the day of surgery.

My program required residents to phone patients the night before to preop them (even though they'd already gone through the preop clinc). This was supposedly for resident education, though I don't think I ever learned anything from the experience, except that it sucked to be hazed in that way. The 10-banger peds ENT days were easily an hour plus of pointless phone calls. I quietly quit doing it about 1/2 way through residency ...

I've seen a couple of groups that had a policy of the anesthesiologist phoning each patient the night before, but that was in the name of good warm and fuzzy customer relations, not for medical reasons. I guess there's something to be said for that.
 
You proceed according to your judgement. Knowing that the patient is I'll beforehand will not change the next steps. URI will not heal magically, cobsultant will not accomplish anything of value by setting the patient at 10pm., most consultants will not even come at night.

I presume you preopped those patients the night before and the case still got cancelled, right?

Yep, or we sit around twiddling thumbs and delay the case until the get the appropriate clearance. Though the patient population here takes very poor care of themselves, and the surgical service leaves all the medical management to us (ignores significantly hypertensive patients, or those with out of control diabetes).
 
Only two useful reasons I've found for preops on inpatients the night before:
1) AICD that needs to be shut off prior to surgery, as a call to Cardiology at 700AM for a 715AM start always results in a late in-room time.
2) Phone consents on patients that are unable to consent themselves, especially first-starts.
.


We put magnets on all and have cardiology interrogate in PACU. We are not required a separate consent either.
 
I used to do preops the night before during my residency as well. The 'educational benefit' was lost by early CA2 year. The main reason I continued to do them wholeheartedly was to save time during the morning of surgery. Having a preop done and the chart analyzed makes turnover ALOT faster.
 
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We preop and anesthesia consent all inpatients prior to leaving for the day, regardless of whether or not they are going to be in our OR.

-Useful when a case needs to be cancelled on a floor patient. All ICU patients get preop updates day/morning of surgery for vent settings and overnight events.
-Cancelling a case the night before means no delay when the surgery team adds on another patient in their place.
-A huge percentage of our case load cannot consent themselves [county hospital, lots of polytrauma/ICU patients coming to the ORs], and sometimes their next of kin are...elusive.

All outpatients and AM admits go to preop clinic. for my [CA1] purposes, it is useful to the extent that I know how to set up my room and what drugs to pull from our out-of-OR pyxis prior to starting my cases for the day.

I mean, it gets old at times, but I certainly think that there are benefits to knowing what you are walking into the next day.
 
I still preop my patients--certainly the early starts--the night before. Lots of them I call. I want perfect outcomes every time--not that I get them. I also want my patients to know I care about them, especially in those not-so-perfect instances. I just shake my head whenever I ask a partner in the morning locker room, "so how's your day looking" and they respond with the "I have no idea."
 
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Where I am, it is mostly about getting consent, specifically phone consents .
 
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Consent for what?

Anesthesia consents are unnecessary. It's included in the surgical consent. What do you give the patients the option of? A leather strap or anesthesia?
 
Consent for what?

Anesthesia consents are unnecessary. It's included in the surgical consent. What do you give the patients the option of? A leather strap or anesthesia?
Anesthesia! Although I do agree implicit with signed a consent to have surgery there is a need for anesthesia, that isn't comepletly adequate. For example, does that mean the risks and benefits of spinal vs GA for hip were described and understood.
 
At the same time, I think obtaining a consent on the day before/of an elective surgery will sooner or later be deemed as insufficient, because of the patient's psychological status.
 
Reality is that there are no alternatives other than what you are willing to offer. Urologist doesn't want spinals, you aren't going to offer it.
 
At the same time, I think obtaining a consent on the day before/of an elective surgery will sooner or later be deemed as insufficient, because of the patient's psychological status.

I think telling patients five minutes before they go to the OR, "you could have a stroke or heart attack or have your teeth knocked out" is a ridiculous, self-serving attempt at CYA that does nothing for our patients except scare them. When I ask patients if they'd like me to discuss the risks of anesthesia, 99/100 say "no thanks."
 
Our training institution had staggered releases. Post calls, early outs, regulars, dinners, lates, and call. The regulars and anyone later than that couldn't go home unless all the pre-ops had been seen. If one snuck out, he/she was called back. Thus, the call people didn't have to go do all the pre-ops at 10 or 11 PM. Since all were on call at various times, all realized the benefits of working as a team.
 
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