Preop Labs

[joncmarkley]

---

Members do not see this ad.

Hello

Does anyone know of a resource that has a list of suggested studies (blood work, xrays, ekg) based upon a patients age, risk factors, and surgery type.

I know everyone is different, I am just looking for something I could hand out to the surgeons who don't send their patients to our PAT clinic

Thanks

 

[toughlife]

Hello

Does anyone know of a resource that has a list of suggested studies (blood work, xrays, ekg) based upon a patients age, risk factors, and surgery type.

I know everyone is different, I am just looking for something I could hand out to the surgeons who don't send their patients to our PAT clinic

Thanks

The resource is called 'using your brain'. Go see the patient the night before and order whatever test you deem necessary based on your evaluation of the patient and his/her medical history.

 

[fakin' the funk]

The resource is called 'using your brain'. Go see the patient the night before and order whatever test you deem necessary based on your evaluation of the patient and his/her medical history.

"Oh you academics and your unnecessary testing! If you ever came out of your ivory tower, you'd be eaten alive in the real world of private practice ordering all those tests!"

There, I think I beat MilitaryMD to it.

 

[militarymd]

"Oh you academics and your unnecessary testing! If you ever came out of your ivory tower, you'd be eaten alive in the real world of private practice ordering all those tests!"

There, I think I beat MilitaryMD to it.

Pretty darn close.

Just look in the literature....the trend is almost no testing.

 

[mille125]

Hello

Does anyone know of a resource that has a list of suggested studies (blood work, xrays, ekg) based upon a patients age, risk factors, and surgery type.

I know everyone is different, I am just looking for something I could hand out to the surgeons who don't send their patients to our PAT clinic

Thanks

thread should be called "how to waste money and medical resources"

 

[fakin' the funk]

I know everyone is different, I am just looking for something I could hand out to the surgeons who don't send their patients to our PAT clinic

Isn't the reason that anesthesiology (and hospitalists) is moving into periop medicine/preop optimization that the surgeons were ordering way too many labs and wasting time/money/resources (as said above)?

 

[joncmarkley]

I am very disappointed in the way you have all reacted to me. Very rude how you all jumped down my throat. I did not say I don't know what to order when. I only said some patients do not come to our PAT clinic and their surgeons are consistently ordering cbc, sma, coags, ekg, xray on all patients regardless of age. They do not have the insight to determine what is needed (not all but MOST) I was approached my administration to supply an evidence based resource to help guide them. I thought maybe you guys would be helpful but I was wrong.

Later

 

[VolatileAgent]

if it's a potentially bloody surgery, i want to know the h&h at the very least. if they've been on oral anti-coag therapy for whatever reason, i want to know the PT/INR the day of the surgery.

call me wasteful.

 

[Planktonmd]

I am very disappointed in the way you have all reacted to me. Very rude how you all jumped down my throat. I did not say I don't know what to order when. I only said some patients do not come to our PAT clinic and their surgeons are consistently ordering cbc, sma, coags, ekg, xray on all patients regardless of age. They do not have the insight to determine what is needed (not all but MOST) I was approached my administration to supply an evidence based resource to help guide them. I thought maybe you guys would be helpful but I was wrong.

Later

Don't take it too personal, the responses you got are a direct result of the new era of medicine where everything is about saving money, it becomes drilled in the heads of new physicians that they need to do everything to save HMO's and Insurers money to a point that every time someone mentions the key word "preop labs", you get these memorized sarcastic responses.
I think the best answer is to encourage your surgeon's to act like doctors, do a review of systems with the patient and order labs according to area's that could be problematic. example: Kidney problems ---> order chemistry, Alcoholic ---> order liver enzymes and coags, Major surgery ----> order H/H and type & cross.......
It's simple common sense, also advise them to read the guidelines for non cardiac surgery on patients with heart disease, you can actually print these out and give it to them, they are way more important than routine labs.

 

[iron]

I believe there is a chart in the back of Anesthesiologist Manual of Surgical Procedures by S. Fischer. Same author has a short article in an issue of CHEST that is pretty good with a chart outlining diagnosis based pre-op testing. It also has a short review of various tests: pregnancy test, coags, etc.

http://www.chestjournal.org/cgi/content/abstract/115/suppl_2/96S

 

[joncmarkley]

Iron...thank you so much. The chest article was perfect, you saved me a few hours of typing.

Jonathan

 

[Mman]

Perhaps a platelet count might be nice if they are a candidate for neuraxial anesthesia and coags if any concern for bleeding risk for neuraxial or regional anesthesia.

 

[urgewrx]

Perhaps a platelet count might be nice if they are a candidate for neuraxial anesthesia and coags if any concern for bleeding risk for neuraxial or regional anesthesia.

You need a platelet count to do a spinal? Interesting.