A successful practice: Pre-Admiting Test Center

Abstract

THE PRE-ADMITTING Test Center (PATC) at Brigham and Women’s Hospital (Boston, MA) was originally developed in response to a national movement from the traditional screening of patients on an inpatient basis to the outpatient screening of surgical patients. The center was developed under the department of admitting services and was moved to the Department of Surgical Services under the direction of Dr Angela Bader, an anesthesiologist with a specific interest in preoperative evaluation, in 1998. Since 1998, an anesthesiologist has been responsible for the reporting lines and budget, and for developing a comprehensive process that would provide high-quality patient care and improve outcomes while providing costefficient care. Anesthesia involvement in the management of surgical patients in a preoperative clinic has been shown to decrease unnecessary testing and costs, reduce OR delays and cancellations, and improve patient and physician satisfaction. The PATC at the Brigham and Women’s Hospital evaluates 22,000 patients per year. Most of these patients are of high acuity undergoing complex surgical procedures. On an average day, 80 to 90 patients visit the PATC, and about 10 patients are evaluated by a nursing phone screen. The PATC anesthesia team includes an anesthesiologist, CRNA, and a selected group of anesthesia attendings who have an interest in this area. Anesthesia residents do a rotational experience here as part of their clinical training. In addition, 5 nurse practitioners and 2 physicians assistants perform surgical histories and physicals. Three nurses, 4 laboratory technicians, an administrative manager, and clerical support staff are also members of this efficient team. Consults are provided by a cardiologist who is available to the PATC as needed. Anesthesia residents should be involved in preoperative assessment as part of their curriculum to improve diagnostic abilities and operative risk assessment skills, develop interviewing skills, improve the anesthesiologist-patient relationship, and provide exposure to the management of a preoperative clinic. The practice of anesthesia providers dedicated to the PATC has provided a reduction in delays and cancellations. Issues are also addressed by anesthesia staff dedicated to improving outcomes. The scheduling of surgery is accomplished through the Admitting Department and a sophisticated computerized program of “one-stop shopping.” One phone call from a physician’s office schedules the surgery through a computerized template. At this time, any necessary special equipment is scheduled and a PATC appointment is arranged with the necessary providers. Based on written guidelines, the patient is scheduled for a PATC appointment or a phone screen. These should occur a minimum of 72 hours before surgery. An information packet including laboratory orders, patient information, and a completed PATC checklist, must be brought to the PATC by noon the day before the patient’s appointment. A phone number of the patient’s primary care provider and cardiologist, if applicable, are provided. If the patient has a cardiac history, a copy of the most recent electrocardiogram (EKG), echocardiogram, Ellen E. Sullivan, BSN, RN, CPAN, is the Nurse-in-Charge in the PACU at Brigham and Women’s Hospital, Boston, MA. Address correspondence to Ellen E. Sullivan, BSN, RN, CPAN, 137 Tiffany Rd, Norwell, MA 02061; e-mail address: ellens@aol.com. © 2001 by American Society of PeriAnesthesia Nurses. 1089-9472/01/1603-0010$35.00/0 doi:10.1053/jpan.2001.24276