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.

Want to break anesthesia of its 10 most annoying habits — and replace them with good ones? See Lynette Bear, DNP, CRNA, MNBA, at OR Excellence, Oct. 3-5, in Fort Lauderdale, Fla. Register at orexcellence.com.

Many say having anesthesia and surgery is the ultimate stress test for patients. Those with previously untreated or undiagnosed medical conditions might be at risk for complications during or after surgery if they’re not treated before surgery. Anesthesia might feel that the patient is safe for surgery, but fear complications after surgery. Delaying the surgery to tune up the patient could be the best decision. If you delay or cancel a patient, provide clear next steps, schedule appointments and follow up to get the patient back on the schedule as soon as she’s cleared.

Part of the solution

We all want the same things: patient safety, strong outcomes and high patient satisfaction. So why is it so hard to find common ground? Administrators and anesthesia speak different languages. Each may be listening, but nobody is heard. Many cancellations are not “anesthesia’s fault,” but rather a reaction to other factors and issues. Clear, updated policies and guidelines support decisions to move ahead with surgery or delay. Involve your anesthesia team in policy-making decisions. They’re a wealth of information and happy to volunteer to be part of the process. And part of the solution. OSM