The Department of Anesthesia and Critical Care at the University of Chicago has been a leader in the development of the Anesthesia Perioperative Medicine Clinic (APMC).
The goals of the clinic are as follows:
- To enhance the comfort and safety of patients coming for surgery.
- To coordinate care with the patient's perioperative team.
- To optimize the use of medical resources in providing care through avoiding unnecessary preoperative testing.
- To minimize preventable day of surgery cancellations or delays.
The goals are met by evaluating the patient in clinic several days before surgery. The patient meets with various members of the preoperative care team. APMC staff include medical assistants, advanced practice nurses, medical students, residents and attending anesthesiologists. A medical history and physical examination is performed and diagnostic tests are arranged if needed. Blood work and electrocardiograms can be performed right in clinic. Occasionally additional consultation with other physicians is required and the plan is discussed with the patient's existing care team. The anesthesiologist or advanced practice nurse then formulates a preliminary anesthetic plan, discusses it with the patient, and answers any questions. The clinic ensures that the tests and consultations are arranged and that the results are reviewed by a physician. The visit may take 45 minutes for a generally healthy patient to over 2 hours for a medically complex patient.
Timely evaluation before surgery gives the patient an opportunity to discuss the planned anesthesia in a relaxed environment. This opportunity has been shown to significantly reduce preoperative anxiety. The physician also can take as much time as required to assess the patient's needs. The use of resources is focused on necessary tests and referrals. Surprises on the day of surgery are prevented, which might otherwise delay surgery if additional medical information is needed or workup of a previously unidentified medical condition is required to formulate a safe anesthetic plan. The importance of this method increases as the rate of outpatient surgery or same day admission surgery increases, now exceeding 60% of all procedures at the University.