Procedure Readiness Evaluation and Preparation (PREP) Center
All charts for patients coming for same day surgery (SDS) or admit on day of surgery (AMADMIT) procedures at the University of Maryland Medical Center originate in the PREP Center.
About 40-50% of these patients are seen in the PREP Center by our nurse practitioners for a pre-operative history and physical. The anesthesiology residents evaluate patients prior to scheduled procedures and then discuss the cases with attending anesthesiologists. Together, we determine - based on the patient's history and the nature of the surgery - which preoperative tests (if any) are necessary to approve the patient to safely undergo the proposed procedure. Preoperative testing could include an EKG, laboratory testing, chest x-rays or consults from other medical specialties (such as cardiology).
When patients are not seen in the PREP Center prior to a scheduled procedure, a nurse practitioner reviews all available medical information and calls the patient at home to get information regarding the patient's past medical and past anesthetic history. The clinicians in the PREP Center make an effort to gather medical information in order to facilitate the pre anesthetic evaluation that will take place on the day of the procedure. This can prove to be very challenging when the needed medical records are not available in time.
The only patients whose charts do not originate in the PREP Center are those who are inpatients at UMMC or are admitted emergently and undergo surgery emergently.
In the PREP Center, we believe in a team approach to evaluating patients before their procedures. Clerical staff, patient care technicians, nurses, nurse practitioners, anesthesiology residents and attendings all work together to improve patient readiness and safety for their procedures scheduled at UMMC. On occasion, we also have medical students and CRNA students rotating through the PREP Center.
The patients who have an appointment in the PREP Center, receive pre-operative teaching, including detailed instructions regarding the continuation or discontinuation of their medications. During the PREP Center visit, the patients also receive information on peri-operative infection prevention measures, such as pre-operative showers/scrubs and peri-operative management of diabetic medications. Patients coming for specific operative procedures also receive prescriptions for pre-operative administration of a topical antibiotic ointment that is applied to the patient's nostrils prior to the procedure to further reduce the risk of peri-operative infections.
Furthermore, the patients are instructed regarding the pre-operative fasting guidelines, which allow most healthy patients without contraindications to consume clear liquids until two hours prior to their arrival time on the day of surgery.
A one page patient screening tool was designed to help decide who should be seen in person and who could be “chart review with phone call”. A four-page pre-operative patient questionnaire form was specifically designed with the peri-operative patient in mind. It is either faxed to the PREP Center ahead of the patient's appointment or can be filled out while the patient is in the PREP Center. There is also the option of filling this questionnaire out online at the convenience of the patient.
PREP Center Medical Director:
Beatrice Afrangui, M.D.
Medical Director, PREP Center
Assistant Professor of Anesthesiology
Department of Anesthesiology
University of Maryland Medical Center
Phone: (410) 328-5750