The results prompted us to revamp our system for contacting
patients before they arrive at our facility for surgery.
• Anesthesia involvement. You can review all the charts you want
the day before a patient's surgery, but it's nothing like talking to the
patient. Who talks to the patient is also important. A perioperative
nurse will read a chart differently than an anesthesia provider will. A
CRNA will notice, for example, that the patient doesn't have cardiac
clearance, and had a cardiac event six months ago. The scheduling
surgeon or the perioperative nurse might not have picked up on that
important cause for concern. Using a CRNA to make the call as
opposed to an anesthesiologist is a more efficient use of resources.
• Tag team calls. Perioperative nurses still contacts patients the day
before their scheduled procedures and go through the usual script —
when and where to show up, which medications to take and which
not to take, when and what to eat and drink, what to wear, what to
bring and so on. Once nurses are finished, they hand the phone to
CRNAs (both are on the same call, so we don't bother the patient
twice), who perform pre-op assessments and, if there are any red
flags, immediately consult with the anesthesiologist.
• Scripted questions. In order to give CRNAs as many tools as pos-
sible to discern disqualifying issues during conversations with
patients, we developed a protocol in close cooperation with our
department of anesthesia. This assessment form, based on a validated
and reliable anesthesia script, helps CRNAs examine and evaluate sur-
gical patients over the phone.
They can uncover things like a questionable medication regimen,
outdated lab results, a need for an in-person consultation, the lack
of a specialist's clearance, new symptoms, new diagnoses and much
more. During our study, for example, a CRNA noticed a patient's
breathing pattern was peculiar over the phone and brought it up
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