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Process:

Who is involved: 1) Surgeon; 2) Anesthesiologist; 3) Any existing physician of the patient with a co-morbidity and/or surgical consulting
physician related to a co-morbidity or a health concern of the patient.

When Is Decision made: During the final surgical visit
During preoperative assessment
During medical consults
How is Decision made:
• At the final surgical visit when the surgeon recommends surgery, he will also evaluate any condition or co-morbidities
and determine what medical follow up(s) is/are needed including added testing for pre-op assessment and added
medical consults. This includes the decision about whether or not a medical condition needs to be stabilized before
undergoing any surgery. If the surgeon deems the patient is better off as an inpatient, no additional decisions need to
be made.

• At the pre-operative assessment, the anesthesiologist will conduct a thorough functional review all of the
patient’s conditions and potential risks for surgery. If needed, added tests (lab, imaging) will also be conducted. If the
surgeon recommended day surgery, the anesthesiologist will also evaluate whether day surgery is safe and make a
recommendation. The goal is to eliminate any risks or concerns surrounding day surgery. If the anesthesiologist
recommends that an inpatient stay would be preferable, he/she will contact the surgeon with findings.

• If there are additional concerns and day surgery has been recommended by both the surgeon and the anesthesiologist,
any additional medical visits will also be added to the decision as to whether the patient is fit for day surgery.

For example, a patient with a cardiac condition may need a Cardiologist consult. If the patient’s cardiac condition is
stable and the Cardiologist signs off, the patient will undergo day surgery. Before the patient is discharged, however,
the protocol includes a review of vitals and an EKG to ensure that all is normal.

Patients with cardiac conditions, even stable, will be admitted if they live more than 30 minutes away from the hospital.
If the medical specialist determines that day surgery is not safe/not advisable for any medical reason, he/she will contact the surgeon with findings.
The questions each specialty will determine, when considering day surgery versus inpatient surgery are:

1. Do the risks of going home the same day outweigh the added risks inherent in an inpatient stay?
2. Is there anything that can be done for this patient by admitting him/her overnight which could or should not be done at home or that [e.g.,
monitoring for cardiac stability.)

The Shoulder and Upper Limb Unit