Pre-procedure Services (PPS)
Clinic Staffing:
Medical Director: Angela Selzer, MD Rotation Director: Jillian Vitter, MD
You can address any questions/concerns/suggestions about the clinic or rotation to either Dr. Selzer or Dr. Vitter.
Daily Attending: You will work directly with an assigned attending anesthesiologist every day. There is a specific team of anesthesiologists assigned to clinic and this person will usually vary daily.
Clinical Director: Katie Conyers, NP is the lead NP and Clinical Director of the clinic.
Nurse Practitioners: There are currently eight other NP/PAs working with Katie in the clinic.
Nurse Manager: There is a nurse manager for the clinic who supervises and manages the operation of the clinic and the RNs, MAs and PARs.
Charge Nurse: There is a charge nurse who helps with the daily management of the clinic.
Registered Nurses: There are approximately ten RNs in the clinic, some of whom assist with scheduling and coordinating clinic patient appointments, the rest are dedicated to calling patients prior to surgery and obtaining a thorough history over the phone.
Medical Assistants: There are four MAs in the clinic. They room the clinic patients, take vitals, draw labs and EKGs. They also assist with scheduling, check-in and record retrieval.
Patient Access Representative: There is one PAR who checks in patients and schedules upcoming appointments.
Pre-op Overview:
Preoperative medicine is a unique subspecialty within the field of anesthesiology. The successful preoperative management of patients has been shown to lead to better outcomes: reduced morbidity and mortality, decreased hospital lengths of stay, improved patient experience and a reduction in OR cancellations and delays. The field of preoperative medicine is expanding, and hospitals are looking to anesthesiologists to help manage and run hospital preoperative clinics.
Our primary goal with this rotation is to ensure that each resident graduates capable of performing a thorough evaluation and able to implement evidence-based plans for preoperative assessment and optimization. However, we also seek to expose residents to the basic understanding of how a preoperative clinic is run, managed and financed in order to assist them in their future careers and enable them to contribute to this burgeoning subspecialty.
At our Pre-Procedure Services Clinic, in the University of Colorado Anschutz Campus, we see approximately 6,000 patients/year. These patients have complex comorbidities and are mainly ASA 3’s & 4’s. During their one-month rotation (for interns), or two-week rotation (for CA1-CA3s), residents will see from 40-60 patients of their own, supervised by an attending anesthesiologist, and complete a preoperative medicine curriculum.
Goals
To learn how to obtain a comprehensive medical history.
To perform a comprehensive physical examination
To gain proficiency in point of care ultrasonography
To appropriately order necessary diagnostic studies and tests
To formulate an individualized pre-habilitation plan for each patient
To integrate the information obtained to determine that a patient is adequately optimized or to develop a plan to optimize the patient further.
To develop an appropriate anesthesia plan and communicate it to the patient.
To understand the basics of how a functioning preoperative clinic is staffed, managed and financed.
The Details
Clinic Location: AOP, First Floor, near Dazbog. Follow signs to Pre-Procedure Services.
Clinic Phone: x81263
Prerequisites: Prior to starting your rotation, you will need to make sure that you have the appropriate EPIC access and have completed E&M training (these visits will primarily be billed as level 3-5 consult visits). You will have received information on how to complete this training, but you need to make sure that this has been completed prior to day one of the rotation. We recommend stopping by clinic prior to the start of the rotation to check in.
Clinic Hours: The clinic is open from 8am-5pm.
Daily Schedule: You will be seeing around 3-6 patients per day. The visits are scheduled for one hour. Your patients will mostly be scheduled in advance, but you may have one or two “walk-ins” or last-minute add-ons. We try to see patients a week before surgery, but more typically see them 2-4 days prior to surgery. Day before cases are made as exceptions primarily for patients travelling from out of town.
The expectation is that you have completed a chart review prior to seeing the patient and will have an idea of what additional information and testing are needed prior to the appointment.
The schedule will likely look something like this:
Day 1: Morning: Orientation & 1 patient visit, Afternoon: 2-3 patient visits
First Half: 3-4 patient visits/day
Second Half: 3-6 patient visits/day
Daily Responsibilities
3-6 Patient consults:
Pre-visit chart review
Review of systems, history taking and focused physical exam (if in-person visit)
Presentation of findings and plan to attending
Evidence based ordering of labs/EKG/testing, requests for records if applicable.
Providing an After Visit Summary to patient with day of surgery instructions
Completion of consult note in timely fashion.
Follow up on labs/testing, addendum to notes when applicable.
Assist with NP/RN questions about anesthesia and preoperative evals.
Rotation Responsibilities
Before the end of the rotation, you will present an article to the PPS clinic MDs, NPs and RNs. The article should be approved by a Preoperative Medicine Attending.
You will also complete a preoperative curriculum, which will include daily reading assignments and topics for discussion with your assigned attending. This will be provided to you prior to the start of your rotation.
The POCUS curriculum has been moved to a part of the PPS rotation. You will be required to review some materials pertinent to POCUS prior to starting the rotation. You are also expected to discuss/consent each patient for a brief POCUS while in clinic.
You will be invited to attend clinic meetings where appropriate in order to get a better idea of how outpatient clinics are run.
EPIC Logistics: The clinic uses certain templates for note writing, after visit summaries, and risk calculators. There is a “how-to” with screenshots on the Teams Page and you should receive it by email (ask for it if you don’t!) Make sure you ask to have these shared with you before your first day.