After the Pre-Operative Assessment

This section outlines decisions and actions that are to be taken as standard following the Pre-Operative Assessment of the patient.

Each patient is deemed to fall into one of the following categories:

  1. fit to proceed with no modifications to treatment or further tests required.
  2. fit to proceed with modifications to medications.
  3. fit to proceed with referral back to GP or to other medical specialty for optimisation or ongoing review.
  4. further review/input by consultant anaesthesiologist.
  5. defer until identified issue is resolved/optimised.

A chart review form should be completed. This form, and a copy of the patients blood test results and ECG (if recorded), should be forwarded to the patients GP.

Categories following POAC assessment

1. Fit to proceed with no modifications

Patients who fall into this category can receive a standard form that will be sent to their GP, and copied to their DMR, stating that they have been assessed and are fit to proceed with no changes to their treatment.

2. Fit to proceed with modifications to medications or non-standard investigsations

It is often necessary to make modifications to the medications that a patient is taking pre-operatively. For example, if anticoagulation is not stopped correctly then the patients procedure will almost certainly be deferred.

It is important to record any modifications that are made to the patient’s medications in their DMR and to communicate these changes to the patient’s GP.

3. Fit to proceed with consideration of referral for further management

This category includes patients in whom a medical anomaly is found that may require further management or surveillance.

Referrals can be made to either the patients GP or to other specialties if particular abnormalities are uncovered during Pre-Operative Assessment.

4. Requires further review by anaesthesiologist

The criteria for consultant review are set out in various parts of this guide. In particular, patients with METS < 4 (as measured by the Duke Activity Status Index) must have a SORT risk score calculatrd, and a review by a consultant anaesthesiologist.

If the surgery is urgent (e.g. as part of cancer management), do not defer procedures but seek immediate review by a consultant anaesthesiologist.

5. Defer until particular issue resolved

Some issues require that surgery is automatically deferred until an issue is resolved. These include:

  • New onset arrhythmia (this may require cardioversion and/or anticoagulation)
  • Haemoglobin < 8 g/dL
  • Evidence of active infection that is untreated
    • if a patient is currently undergoing treatment for an infection, ensure the consultant surgeon is informed of this fact, and seek consultant anesthesiologist review.

Communication of the result of POAC visit

Ideally, the patients GP will receive a copy of the key information generated during the patients visit. This includes:

  • a copy of the POAC assessment form
  • a copy of the results of blood tests performed
  • a copy of an ECG (if one was performed)