Vancouver Acute Department of Anesthesia

Perioperative Anesthesiologist (POA) Duties

 

POA Priorities:

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1. Care of patients in the IPACU/PACU

2. See inpatient anesthesia consultation follow-ups

3. Complete new anesthesia consultations

4. Attend Complex Clinical Case Conferences

 

PACU Care:

 

Upon arrival at 13:00, the perioperative anesthesiologist (POA) should meet up with anesthesiologist responsible for the PACU in the morning (PAIS or sometimes D1), and the pager should be handed over. A bedside round should occur on patients in the Intensive PACU (IPACU) in the presence of the nurse in charge (Dianne or Rea), and handover regarding any issues with patients in the regular PACU should be passed on. During the handover, consideration should be given to the following:

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• Does this patients’ post-operative course correspond with what would be expected of their medical co-morbidities and their surgical pathology?​​​​​

• Is there anything that would suggest a patient may require an escalation in their care and consideration for ICU consultation?

 

• Where is the anticipated discharge disposition?

• What is the anticipated time of meeting discharge criteria?

• Any nursing concerns for this patient?

• Are there any pending investigations, consultations or a need for discussion with surgery that requires follow-up?

 

It is the responsibility of the POA to round on all IPACU patients, and deal with any issues in their care. A clear care plan needs to be established for every patient. It is the responsibility of the POA to ensure an admission note and regular progress notes are present in the patient’s chart. Any patient that you (or a colleague) deem appropriate for critical care billing requires at least one note. The note should include the patient’s active issues, how these issues are being addressed, and a disposition plan.

 

The IPACU is a ‘closed unit’ meaning that our department is ultimately responsible for all the orders written.  Be attentive to orders written by junior surgical residents that may not be in the best interest for the patient you are caring for. The POA should take an active role in the care of other PACU patients where required, and liaise with the intraoperative anesthesiologist, POPS anesthesiologist, surgeon, and consultation services where applicable, to facilitate timely and optimal patient care.

 

Early ICU consultations should be requested for critically ill patients in multi-organ failure, or where there is a reasonable chance that the patient would not be ready for PACU discharge in less than 48 hours. If you have any question if a patient is appropriate for the IPACU, please refer to the ICU Referral Guidelines for Patients in the Intensive PACU document (attached) or consult with a colleague. We have a collegial relationship with the ICU. It is encouraged to discuss referrals with either the ICU staff or fellow on for intake directly, and to bypass discussion with residents.

 

The POA should assist with patient triage from PACU, by maintaining open communication with both the D1/ N1 anesthesiologist and the PACU charge nurse. A handover of the patients in the PACU should be given to the N1 anesthesiologist, identifying all active issues and relaying the current care plan prior to leaving at 21:00.

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Perioperative Anesthesia Inpatient Consults and Follow-Ups:

 

When the POA is satisfied with the status of the patients in PACU, s/he should liaise with the Slater in selecting a manageable number of the most appropriate inpatient consults to be done from the Inpatient Anesthesia Consultation Inbox (on the ledge outside the slating office). This number to complete varies depending on how busy PACU is, whether you have a trainee assigned to POA that day and the seniority level of that trainee.

 

The POA should also review the Inpatient Anesthesia Consultation Follow-up bin for any follow-up required on previous consults (eg. consultations, echocardiograms, etc.). The POA is responsible for all consultation follow-ups. It is important to follow up on these action items in a timely fashion as a final anesthesia approval may be required before a patient is cleared for the OR. A note should be included in the patient’s chart to make it clear if a patient is suitable to proceed to the OR. Copies of completed consults should be filed in the Completed Anesthesia Consultation bin, with a completed Consultation Summary document attached. Completed consults should not be placed on the white board outside the slating office. An attempt should be made to dictate consultations whenever possible to facilitate uploading onto PCIS.

 

Complex Patient Care Conference (CPCC):

 

It will be the responsibility of the POA to represent the department at CPCCs.  A CPCC should be considered when one-on-one discussion with key players would be suboptimal to address complex perioperative patient management issues.

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When the need for a CPCC is identified during an ACC or inpatient anesthesia consult, the consulting anesthesiologist should complete a CPCC referral form and hand it to Brenda to organize the meeting with the surgeon and subspecialists between the hours of 13:00 and 16:00 M-F. If you are scheduled to the POA position on the day of the meeting, you will be contacted. Every effort should be made to have the anesthesiologist requesting the conference to be in attendance. It is your responsibility to:

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1. Familiarize yourself with the case and the key issues

2. Facilitate the meeting

3. Summarize the care management plan on the reverse of the CPCC form

4. Dictate an addendum to the anesthesia consult highlighting the management plan for the patient

5. Place the completed CPCC form in the basket in the back room of the Anesthesia Office.

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