Archive August 2018 XIX, No. 8

Anesthesia Alert: Cancellations Aren't Always Anesthesia's Fault

When a case is postponed, there's often plenty of blame to go around.

Lynette Bear

Lynette Bear, DNP, CRNA, MBA

BIO

WHO'S TO BLAME?
WHO'S TO BLAME? Just as there are many reasons for same-day cancellations, there's plenty of blame to spread around.

What’s your biggest anesthesia gripe? Take your pick of the 3 C’s: cancellations (too many), costs (too much) or communication (too little). We don’t have the time or space to address them all, so let’s tackle the one you’re likely losing the most sleep — and reimbursement — over: same-day cancellations.

If you’re like most facilities, you rely on the surgeon for an office visit H&P and on one of your nurses to call the patient before surgery to verify the history, NPO status and which medications to take or stop. Day of surgery arrives and you’ve checked all of the boxes. The H&P labs and testing are on the chart. The surgeon has spoken with and marked the patient. You are ready, the IV is started and the room is opened. But things come to a screeching halt when anesthesia cancels the case after assessing the patient, leaving an unhappy patient, a riled up surgeon, wasted supplies and an OR crew with nothing to do in his wake.

Why on earth did anesthesia cancel? Many cancellations are not anesthesia’s fault. Perhaps your ambiguous policies are to blame. Or your pre-screening system failed to identify red flags.

Just following your policy

Remember, anesthesia’s role is to quickly review the information, assess the patient and determine if the patient is a safe candidate for surgery. Take, for example, a patient who has obstructive sleep apnea (OSA). Your policy states that you’ll cancel the case if an OSA patient doesn’t have her CPAP with her. The anesthesia provider might feel he can safely care for the patient with a multimodal approach, but your unyielding policy doesn’t support this practice.

What about white blood cell counts that are too high? This might also be grounds for cancellation, per your policy. But if the patient is asymptomatic, doesn’t have a shift, and the surgeon and anesthesia are aligned, the case could move forward, right? Not unless anesthesia wants to violate your policy. Asking a provider to “make an exception” or “bend the rules” often puts him in an untenable situation from a legal and practice standpoint.

Then there’s incorrect or incomplete health information. With more insurers denying medical testing, many patients don’t have complete health information. Ever hear a patient say, “That pain in my chest ain’t nothing more than a little heartburn” when in fact the patient has a heart history and hasn’t been worked up in 5 years? Or perhaps you have one of those “healthy patients” who “never needs to go to a doctor.” But in pre-op, anesthesia notes a blood pressure of 220/110 or a previously undianosed irregular heartbeat.

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