Pre-Admission Testing (PAT) is a comprehensive process that evaluates a patient’s health before a scheduled medical procedure, often surgery. This preparatory step is performed by a specialized team, frequently consisting of nurses and anesthesiologists, to collect and analyze medical data. The primary objective of PAT is to maximize patient safety by ensuring the body can handle the stress of the procedure and the effects of anesthesia. Identifying potential health issues allows the medical team to create a tailored plan to minimize risks and prevent complications that might lead to delays or cancellations.
Review of Medical History and Medications
The PAT process begins with a thorough assessment focusing on the patient’s documented health history and current lifestyle. The specialized PAT nurse or physician conducts a detailed interview to review existing conditions, such as diabetes, hypertension, or sleep apnea, which significantly influence the type of anesthesia used and the recovery process. They also inquire about past surgical experiences and any history of adverse reactions to anesthesia, providing a crucial foundation for risk assessment.
A detailed part of this phase is medication reconciliation, which involves creating the most accurate and complete list of every substance the patient is currently taking. This includes prescription drugs, over-the-counter medications, herbal supplements, and vitamins. Many common medications, such as blood thinners (antiplatelet agents like aspirin or anticoagulants), must be temporarily stopped or adjusted before an invasive procedure to reduce the risk of excessive bleeding.
The PAT team provides specific instructions on which medications to hold and for how long, often requiring patients to cease taking certain supplements like fish oil or Vitamin E up to two weeks prior. This systematic review helps identify potential drug interactions with anesthesia or planned post-operative medications. The process ensures that all members of the care team have a unified understanding of the patient’s chemical profile, thereby significantly reducing the chance of medication errors during the transition of care.
Essential Diagnostic Tests
Following the historical review, a standardized battery of physical and laboratory tests is performed, though the exact requirements depend on the patient’s health profile, age, and the complexity of the procedure. Laboratory work involves drawing blood for several analyses. The Complete Blood Count (CBC) measures red blood cells, indicating the body’s oxygen-carrying capacity and screening for anemia, and white blood cells, which can signal an underlying infection or inflammation.
A metabolic panel is ordered to assess general organ function by measuring blood glucose, electrolytes (like sodium and potassium), and kidney function markers such as creatinine and blood urea nitrogen (BUN). These values are important because impaired kidney or liver function can affect how the body processes anesthetic agents and other drugs. Coagulation studies, including tests like Prothrombin Time (PT) and Partial Thromboplastin Time (PTT), determine how quickly a patient’s blood clots, quantifying the risk of excessive bleeding during surgery.
An Electrocardiogram (ECG or EKG) is a common requirement, particularly for patients undergoing major surgery or those with a history of heart disease. This test records the electrical activity of the heart, allowing the medical team to detect undiagnosed arrhythmias or signs of previous heart muscle damage. For patients with known pulmonary conditions or major procedures involving the chest or abdomen, a Chest X-ray may be necessary. This imaging provides a baseline view of the lungs and heart size, helping the anesthesiologist plan for respiratory management during the procedure.
Analyzing Results and Pre-Procedure Instructions
Once all diagnostic tests are complete, the results are meticulously reviewed by the surgical and anesthesia teams to grant a patient “clearance.” This step confirms that the patient is medically optimized to proceed as scheduled. If the review uncovers an abnormal finding, such as uncontrolled blood sugar or a previously undiagnosed heart rhythm issue, the procedure may be temporarily postponed.
In such cases, the PAT team may refer the patient to a specialist, like a cardiologist or endocrinologist, for further evaluation and treatment to stabilize the condition. This process of optimizing health status helps ensure that the body is better prepared for the physical demands of the operation. Only after the abnormal results are addressed, or the specialist provides written approval, is the final clearance given.
The final stage of the PAT appointment involves providing the patient with clear, actionable instructions for the days leading up to the procedure.
Pre-Procedure Instructions
- Patients receive strict fasting guidelines, most commonly requiring nothing to eat or drink, including water, after midnight the night before. This is essential to prevent aspiration under anesthesia.
- The team details practical preparations for the day of, such as showering with an antibacterial soap.
- Patients must remove all jewelry, including body piercings, and makeup or nail polish, as these items can interfere with equipment monitoring or cause electrical burns.
- Patients are reminded to arrange for a responsible adult to drive them home and remain with them for the initial post-operative recovery period.