An expert comments on the preop process.

Dr Pasternak: Bayview uses a preoperative evaluation center (PEC) that is under the management of senior clinical nurses. Bayview has 10 ORs and a surgical volume of 8,000 patients a year. Administratively and clinically, the nurses run the clinic under the direction of an anesthesiologist who is a medical director but who is not on site. We used to have a physician on site who was assigned as medical director. But we found that as the nursing staff became familiar with anesthesia protocols and issues, we really didn’t need a physician on site. The nurses were able to address those issues with physician backup. Over the 10 years Bayview has used this process, case cancellations for elective patients caused by incomplete paperwork have improved dramatically from 17% to essentially zero. The only cancellations we have now are situations where a patient violates basic issues like NPO, or a surgeon may decide surgery is no longer necessary for clinical reasons. The process also has helped reduce unnecessary preoperative testing.