Hospitalists packed the room on Monday for a pre-course brimming with information on how to better care for patients undergoing surgery – a category of care that can involve high-stakes and complex decisions before and after a procedure.
Topics covered in the wide-ranging talks included how to assess risk in those with ischemic heart disease, ways to manage anticoagulants in a variety of patients, the basics of anesthesia, and issues particular to patients with neurologic diseases.
Presenters hit hard on four themes that they said hospitalists need to keep in mind when treating patients who are having surgery: communication, risk assessment, interventions, and medication management.
“If you keep those things in mind then you will do a good job taking care of patients as long as you use good clinical sense,” said pre-course director Kurt Pfeifer, MD, FHM, professor of internal medicine at the Medical College of Wisconsin, Milwaukee.
Throughout the sessions, presenters posed audience-response questions to keep everyone engaged. In her discussion of perioperative considerations involving neurologic diseases, Rachel Thompson, MD, MPH, SFHM, associate professor of internal medicine at the University of Nebraska Medical Center, Omaha, asked whether it’s true or false that 1 in 10 patients with epilepsy will have a seizure on the day of surgery, even if they maintain their normal medication regimen.
The results drew laughter from the audience: 47% said that was true, 53% said false, essentially a coin flip that underscored the reason why they were attending the pre-course. The answer is false. The actual stats are that about 0.8% of adults with epilepsy and 3% of children can be expected to have a seizure on surgery day.
In her talk on using anticoagulants, Barbara Slawski, MD, MS, SFHM, professor of medicine at the Medical College of Wisconsin, said it was important to understand the newest literature when using national guidelines, to consider clotting and bleeding risks when considering bridging anticoagulation therapy, and to make a specific plan for management for each patient.
She emphasized the team approach.
“It’s really important to listen to your surgical colleagues when they’re concerned about bleeding risk,” she said.
Dr. Pfeifer said the hospitalists’ involvement in surgical cases ranges from preoperative assessments, helping handle last-minutes changes in a care plan, managing patients afterward, and postdischarge follow-up.
“When you look at the perioperative continuum, there are a lot of places where we have a role to play – maybe more than anyone else in the equation.”