Preoperative Testing, Management: Addressing a Potential Hospitalist NP Gap
A multidisciplinary approach to preoperative assessment is necessary to ensure optimal patient outcomes.
|The following article is part of The Clinical Advisor's coverage from the 2018 American Association of Nurse Practitioners' annual meeting in Denver. Our staff will be reporting live on original research, case studies, and professional outreach and advocacy news from leading NPs in various therapeutic areas. Check back for ongoing updates from AANP 2018.|
DENVER – Hospitalist nurse practitioners (NPs) should have an understanding of cost-effective and medically appropriate preoperative testing and management, according to research presented at the American Association of Nurse Practitioners 2018 National Conference.
Reduced healthcare spending, increased preoperative care coordination, increased quality, and reduced length of stay can be realized when NPs are appropriately informed and educated.
NPs should follow the Society of Hospital Medicine Recommendations:
- Obtain a thorough history and review of patient's medical record
- Perform a targeted physical evaluation
- Use evidence-based algorithms and tools to assess and risk-stratify patients
- Make evidence-based recommendations
During diagnostic evaluation, the following laboratory studies should be performed: complete blood count, Chem B, urine analysis, HbA1c, prothrombin time/international normalized ratio, and albumin. The following diagnostic tests should also be performed: 12-lead electrocardiogram, 2D echocardiogram, and 2-view chest radiographs.
Evidence-based decision tools involved in preoperative assessment include the American Society of Anesthesiologists Classification and the Metabolic Equivalent/Functional Capacity. The Gupta Perioperative Cardiac Risk Assessment, Geriatric Sensitive Perioperative Cardiac Risk Index, and the Gupta Postoperative Respiratory Failure Risk Assessment should be used for risk stratification.
To assess if a patient needs to discontinue preoperative antithrombotic medication, the NP should:
- Determine if discontinuation is required for the planned procedure
- Tailor discontinuation plan to the patient
- Consider holding antithrombotics for the longest duration listed for each agent when planning a neuraxial block
- Use clinical judgment and take the risk of thrombosis and hemorrhage into account
The researcher stressed the importance of a multidisciplinary approach to preoperative evaluation, and NPs should coordinate with the patient, family, nursing staff, surgeon, anesthesia provider, care coordinator, and specialists in order to achieve the best outcomes.
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Sebach A. Preoperative evaluations for non-cardiac surgical procedures: what hospitalist nurse practitioners need to know. Presented at the American Association of Nurse Practitioners 2018 National Conference; June 26-July 1, 2018; Denver, CO. Poster presentation 115.