Surgery Management Improvement Group - Hospital and Operating Room Management Services
Surgery Management Improvement Group - Hospital and Operating Room Management Services
Surgery Management Improvement Group - Hospital and Operating Room Management Services
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Surgery Management Improvement Group - Hospital and Operating Room Management Services
  • Comprehensive Operating Room Management Consulting Services . . .

    . . . include surgery process and system assessment, cost manage-
    ment, facility evaluation and design, surgery information and bench-
    marking analyses, operating room schedule planning and administration and interim contract management.
    Learn More about Gail Nogle Photography
  • Experience Matters.

    SMI Group brings over 60 years experience to clients coast to coast. We can successfully assist you in every phase of the surgery process, including improving relationships between staff, surgeons & referring physicians. We deliver marketable, cost-efficient programs with the latest technology and techniques.
    Missing a deadline can be costly.
  • Answers. Coast-to-Coast

    Word of our success gets around – and so do we! SMI Group is proud of it's track record, literally from coast-to-coast. Regardless of where you are in North America, let SMI Group demonstrate how we can improve your hospital operation and bottom line.
    Coast-to-Coast Solutions from SMI Group
  • Let's sit down & discuss how SMI Group can help.

    Give us a call and let's talk about your hospital and operating room issues. We'll crunch some numbers and start your plan.
    Don't put it off another day.
    Call 734-327-4000 and talk with John, Sue and Dorothy.
    Let's sit down & discuss how Surgery Management Improvement Group can help
  • Succession Planning for the Operating Room

    SMI Group provides the tools and assistance to plan the management succession for your operating room. Our process identifies key roles, management capabilities of existing staff, and cultivates qualified internal candidates to become tomorrow's perioperative leaders.
    Let's talk about your financial future

Pre-Anesthesia Screening

Surgery Management Group

Purpose & Goal   Surgery Management Improvement Group - Pre-Anesthesia Screening

The purpose and overall goal of Pre-Anesthesia Screening (PAS) is to gather the clinical information necessary for the safe and effective administration of anesthesia through a process that is convenient for patients and physicians and results in efficient surgical throughput.

Surgery Management Group

The Need for Pre-Anesthesia Screening   Surgery Management Improvement Group - Pre-Anesthesia Screening

  1. With the shift to ambulatory surgery and same-day admissions, as many as 90% of a hospital's patients don't arrive at the facility until the day of their
  2. surgery.
  3. This makes it more difficult for nurses and anesthesiologists to get the information they need about patients and to initiate any remedial action (e.g., lab testing, cardiology consults, x-ray exams) warranted by patients' condition.
  4. Oftentimes the results are delays, postponements, and cancellations of scheduled surgery with patients and family being dissatisfied and physicians and staff being unproductive.
  5. Develop a matrix combining patients' health status and scheduled procedure severity with the appropriate diagnostic response
  6. Develop an interview guide to elicit patient conditions triggering additional diagnostic interventions
Surgery Management Group

Functions of the PAS Process   Surgery Management Improvement Group - Pre-Anesthesia Screening

  • Assess patients' medical status as soon as they are scheduled for surgery
  • If needed, obtain diagnostic tests to medically screen patients
  • Identify potential patients at risk
  • Increase patient confidence in how to prepare, what to expect and what they will physically encounter during their surgical stay and how that may affect their care after surgery
  • Inform patients about the risks and benefits of different types of anesthesia
    - Provide patient-specific instructions (meds, diet) for the day of surgery
    - Initiate post-op care expectations for patients and their families
Surgery Management Group

How the PAS Process Should Work   Surgery Management Improvement Group - Pre-Anesthesia Screening

How the PAS Process Should Work
Surgery Management Group

Steps to Establish a PAS Process   Surgery Management Improvement Group - Pre-Anesthesia Screening

  1. Form a multidisciplinary committee (anesthesiologists, PAS nurse, pathologist, radiologist, cardiologist)
  2. Identify patient health conditions indicating:
  3. Identify surgical procedures creating risks independent of patients' underlying health status
    a. Need for additional diagnostics (x-ray, labs, ECG)
    b. Need for specialist consultation (cardiology)
    c. Need for anesthesiologist interview
Surgery Management Group

Patient Health Conditions Indicating Need for an "In Person" PAS Visit

General Health Status  Surgery Management Improvement Group - Pre-Anesthesia Screening

  • Inhibited ability to engage in normal daily activity
  • Requires continuous monitoring at home
  • Recent admission (2 months) for acute condition or exacerbation of a chronic condition
  • Past or family history of problem with anesthesia
  • Personal or family history of malignant hyperthermia
  • Morbid obesity (BMI > 35)

Cardiovascular

  • History of angina, coronary artery disease, myocardial infarction
  • Symptomatic arrhythmias
  • Poorly controlled hypertension (diastolic > 110; systolic > 160)
  • History of congestive heart failure

Respiratory

  • Asthma, COPD requiring medication or with acute exacerbation and progression within the past six months
  • History of major airway surgery or unusual airway anatomy
  • Upper or lower airway tumor or obstruction
  • Home ventilatory assistance
  • Morbid obesity (BMI > 35)

Endocrine

  • Non-diet controlled diabetes (insulin or oral hypoglycemic agents)
  • Adrenal disorders
  • Active thyroid disease

Hepatic

  • Any active hepatobiliary disease or compromise

Oncologic

  • Currently undergoing course of chemotherapy
  • Onocologic process with significant physiologic compromise

Neuromuscular

  • History of seizure disorder or other significant central nervous system disease (multiple sclerosis, myasthenia gravis)
  • History of myopathy or other muscle disorders

Musculoskeletal

Kyphosis or scoliosis causing functional compromise

  • Temporomandibular joint disorder
  • Cervical or thoracic spine injury

Gastrointestinal

  • Hiatal hernia
  • Symptomatic gastroesophageal reflux
Surgery Management Group

Anesthesia Testing Guidelines  Surgery Management Improvement Group - Pre-Anesthesia Screening

Electrocardiogram

  • Age > 50
  • Hypertension
  • Hx Cardiac disease
  • Hx Circulatory disease
  • Diabetes mellitus & age > 40
  • Renal, thyroid, metabolic disease
  • High risk surgical procedure

Chest x-ray

  • Asthma, COPD
  • Cardiothoracic procedure
  • High risk surgical procedure

Serum Chemistries

  • Renal disease
  • Adrenal or thyroid disorders
  • Diuretic therapy
  • Chemotherapy
  • High risk surgical procedure

Urinalysis

  • Diabetes mellitus
  • Renal disease
  • Recent GU infection
  • Metabolic disorder
  • High risk surgical procedure

Complete Blood Count

  • Hematologic disorder
  • Vascular procedure
  • Chemotherapy
  • High risk procedure

Coagulation Studies

  • Hematologic disorder
  • Anticoagulation therapy
  • Vascular procedure
  • High risk procedure
Surgery Management Group

High Risk Surgical Procedures  Surgery Management Improvement Group - Pre-Anesthesia Screening

 

High Risk Procedure Characteristics

  • Highly invasive procedures with expected blood loss > 1,500 cc
  • Critical risk to patient independent of anesthesia
  • Expected postoperative stay in ICU

Example High Risk Procedures

  • Major ortho-spine reconstruction
  • Major reconstruction of GI tract
  • Radical retropubic prostatectomy
  • Major vascular repair
  • Cardiothoracic procedures
  • Major oropharynx procedures
  • Major neurologic repair
Surgery Management Group

Sample Elements of PAS Interview Guide
Basic Demographic Information  Surgery Management Improvement Group - Pre-Anesthesia Screening

Sample Elements of PAS Interview Guide
Surgery Management Group

History of Past Medical Conditions  Surgery Management Improvement Group - Pre-Anesthesia Screening

History of Past Medical Conditions and Health Habits
Surgery Management Group

History of Past Health Habits  Surgery Management Improvement Group - Pre-Anesthesia Screening

History of Past Medical Conditions and Health Habits
Surgery Management Group

Current Health History  Surgery Management Improvement Group - Pre-Anesthesia Screening

Current Health History
Surgery Management Group

Current Medication History  Surgery Management Improvement Group - Pre-Anesthesia Screening

Current Health History
Surgery Management Group

Surgical History  Surgery Management Improvement Group - Pre-Anesthesia Screening

Surgical History
Surgery Management Group

Anesthesia History  Surgery Management Improvement Group - Pre-Anesthesia Screening

Anesthesia History

SERVICES "SNAPSHOT"
Surgery Management Improvement Group - Operating Room Scheduling Management
Operating Room Scheduling Management: Operating room planning is a complex task where numerous resources must be synchronized in order to achieve efficiency. Surgeon availability, operating team scheduling, patient related information (i.e. estimated operating time, priority and diagnosis), equipment, and support resources must all be carefully orchestrated. (learn more)
Surgery Management Improvement Group - Hospital &  Operating Room Management Services
Surgery Management Improvement Group - Anesthesiology Program Consulting
Anesthesiology Program Consulting: A well-defined, coordinated anesthesiology program is essential to a cost and operationally effective, marketable operating room. Areas of evaluation and development expertise include: Program Evaluation and Design, Anesthesiologist/CRNA/ Resident Care Team Process Evaluation, Surgeon Nursing Interrelationship, (learn more)
Surgery Management Improvement Group - Hospital &  Operating Room Management Services
Surgery Management Improvement Group - Ambulatory Surgery Center & Program Development
Ambulatory Surgery Center & Program Development: SMI Group provides hospital and surgery center consulting services that provide ambulatory surgery program development & management solutions. We help you retain & grow Ambulatory Market Share while improving expected surgery outcomes. (learn more)
Surgery Management Improvement Group - Hospital &  Operating Room Management Services
SMI Group, Inc.
P.O. BOX 7590
Ann Arbor, MI 48107-7590
734-327-4000