Main components
- For all patients booked for surgery we check if relevant pathology and imaging has been done – i.e. following up on investigations ordered in PAC or ordering investigations for patients that have not been PACed
- Any follow up jobs that have come up in PAC
- PAC jobs handed over by booking Nurses or registrars (check email and PAC follow-up WhatsApp group)
Note: at a minimum by the end of the week all patients for the following week need to be ready for care (sometimes you will just have patients that you can’t get to come in for Ix until the week of their booking, that’s fine but try to avoid it). Ideally patients planned for the following two weeks will also have been contacted to come in for Ix.
PAC Follow up Document
Our Surgical Liaison Nurses (SLNs) generate and update the elective bookings in the form of an Excel spreadsheet available on the computer shared drive (Toggle to “This PC,” then “Shared” under network locations, then “orthopaedics”. Currently, this is a “read-only file” and can only be edited by the SLNs. I recommend importing that excel file onto our google drive so that you can track your progress (pathology including G&H, imaging, etc.), and our SLNs are very helpful in that they send us a list with the proposed elective surgeries and any changes/ cancellations. Our SLNs are also happy to be contacted directly with questions pertaining to the elective lists.
Now, you can commence working down the list
- Check what procedure is required and check the Ortho PAC Guidelines document (on google drive) for what pathology or imaging is required (as you would in PAC)
- Check their EMR for their PAC admission note – ensure the PAC plan has been executed in full prior to their operation
- Check EMR results – note: recent path/XR = within last 3 months
- If there are no recent bloods/XR on EMR – order Ix and call patient to inform them that they need to come in to get their bloods/XR. (Note down on the PAC F/U document what day they are coming and which hospital so you can follow-up)
- Check results
- If results clear – note date of Ix on sheet and tick RFC (ready for care)
NOTE: if unsure what to order/if XR borderline on 3 months etc. – contact the registrar allocated to the patient’s theatre list (Registrar Roster on Google drive)
Pathology
Our SLNs will send pathology request forms for FBE, extended G&H, UEC, LFTs, and coagulation studies to our major elective joint replacement patients. We are responsible for ordering pathology for all other elective procedures (if indicated). We need to ensure that these are paired with the correct pre-op X-rays (including template markers for hips and knees) with the appropriate views. Generally, imaging should be within 3 months of the procedure date; however, this is not a hard and fast rule. If in doubt about the types of imaging and pathology requests, contact the registrar assigned to the elective case (can be found on google drive) and they will guide you.
Forward your pathology request forms via email to:
whs.dorclinic@dorevitch.com.au AND whf.dorclinic@dorevitch.com.au
You can also send out the pathology request forms via email to the patient to ensure they have a copy if it is misplaced. Note that G&H requests can only be processed at Footscray or Sunshine campuses, other bloods may be processed at Dorevitch collection centres (ensure you forward the results to “Western Health” on the form if collected externally).
Things to look out for:
- Hb/Ferretin:
- Major surgeries: Hb is low and ferritin is low see HOBART protocol to see if patient requires a transfusion pre-op; always touch base with the registrar on the operation to see if they want to go ahead.
- Minor Surgeries: check in with registrar
- HbA1c: If patient has likely uncontrolled diabetes, and HbA1c >7%, let registrar know if they are happy to proceed +/- Endo file review
- ECG: if abnormal, compare to old ECGs, and if new or concerning, ask patient about cardiac symptoms (chest pain, exertional SOB), and discuss with anaesthetics
- Any other abnormal results: check with registrar +/- discuss with relevant specialty
Importance
It is essential that the necessary imaging and pathology requests are completed before the operation date. Understandably, patients may encounter challenges attending to these requests before surgery due to other commitments, and they may express that they can’t complete the pre-op investigations. However, we must educate our patients and stress that delaying such investigations may impede surgery and even risk cancellation.