Preadmission Clinic

  Introduction

Preadmission or also known as the preoperative clinic, is where the patient gets seen before having surgery. Preadmission clinic sees elective surgical patients. This means that the date and type of surgery has already been arranged. Before coming to the Preadmission clinic, the patient has already been reviewed in the the Surgery clinic, where the initial decision to go ahead with surgery is made. The goals of the preadmission clinic is to educate, identify and reduce perioperative risks. There is evidence that preadmission clinic lowers length of hospital stay and healthcare costs.

Who is involved in the preadmission clinic?

There are many different people involved. They can be:

Administrative staff, Nursing staff, Medical staff, Pharmacists, Allied Health (physiotherapists, dietician and occupational therapists etc).

How many people involved in the preadmission clinic varies institution to institution, depending on the level of resources available.

What will I be asked to do in the preadmission clinic?

You will most likely encounter preadmission clinic during your surgical rotation. Your job will be to generally review the patient in a structured format. A good approach is as follows:

• Profile

• Type of Surgery and proposed date

• Living situation (home alone? nursing home? etc)

• Level of independence (Fully independent? Need to use a walking frame? Meals on Wheels? etc)

• History of presenting complaint 

can be quick summary of events eg:

Mr A presented with dysphagia 3 months ago. He went and saw his GP, who organized an endoscopy. The endoscopy was performed 1 month ago and esophageal cancer was found. Case has been discussed at the Oesophageal Cancer MDT 3 weeks ago, and the decision to proceed to Oesophagectomy was made.

• Past Medical History

• Medications (Make sure you ask about over the counter medications as well! Fish oil for example has anticoagulant properties)

• Allergies

• Smoking + Alcohol

• Physical Exam

• Review of systems

• Investigations (blood tests, CT scans, Endoscopies etc)

• Plan

for example

1 Fast on day of surgery

2 Admit under Upper GI team

3 Chart medications

4 Finish rest of Preadmission clinic review

Other helpful tips

TIP#1 Pharmacists are a great help, so make sure that you are nice to them! They can provide you with advice on what medications can be continued and which ones need to be stopped.

TIP#2 If there are any issues that you find during your review, be sure to escalate this to your Senior. Be it the Anesthetic consultant, Surgical registrar etc

For example, Mr A, who presents for oesophagectomy in 4 weeks time, tells you that he has been experiencing escalating episodes of angina, which is new.

Sometimes, it may be hard to get hold of your Senior for a decision to be made. That's OK! The Preadmission clinic is scheduled many days in advance before surgery. Thus, there is always time for things to be reviewed and sorted out. If need be, the patient can always be brought back to the Preadmission clinic.

TIP#3 In hospitals where electronic patient record is used, you can already start filling out your Preadmission clinic note in advance, before reviewing the patient! You can get information from referral letters and past clinic notes. Consequently, before you review the patient, you are already ahead!

Resources

Grocott, M.P.W., Plumb, J.O., Edwards, M. et al. Re-designing the pathway to surgery: better care and added value. Perioper Med 6, 9 (2017). https://doi.org/10.1186/s13741-017-0065-4

Jonathan P. Wanderer, BobbieJean Sweitzer, Angela M. Bader, James P. Rathmell; The Many Benefits of a Preoperative Clinic. Anesthesiology 2016; 125:A21 doi: https://doi.org/10.1097/01.anes.0000488750.72800.05

Tariq, Hassan et al. “Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic.” Health services insights vol. 9,Suppl 1 1-7. 30 Oct. 2016, doi:10.4137/HSI.S40540