By Georgette Woo
Alan Suyama, M.D., didn't want to see another patient go through an experience similar to Ann's. Ann had flown to Honolulu from a Neighbor Island to have surgery, only to have her procedure rescheduled when her lab tests revealed low potassium levels. The second time she came was a repeat of the first. The third time, her potassium level was fine and her surgery went smoothly. But Ann suffered a lot of stress and expense. The physicians, staff and hospital were inconvenienced and lost income. But the cancellations were necessary, right?
Yes and no. Ann's low potassium level was a side effect of her blood pressure medication. During anesthesia, it could have changed her heart rhythm from a steady beat to a life-threatening staccato. Patients who have heart or lung problems, perhaps from smoking or poorly controlled asthma, are sensitive, too.
High or low blood sugar levels, implanted defibrillators, and medications that cause bleeding or interact negatively with anesthesia drugs are other reasons to cancel surgery. But two of the most common reasons are that the patient has eaten that morning or has no one to take them home.
It's frustrating for everyone. "Typically, the patient has been up all night worrying, and this means they'll have to repeat the emotional trauma," says surgeon and HMSA board member Whitney Limm, M.D. But the potential consequences of going ahead include blindness, brain damage or even death.
Suyama, an anesthesiologist with The Queen's Medical Center, specializes in high-risk patients. As a physician, he understands the difficulty of evaluating all recommended tests before surgery. But anesthesiologists, who often meet patients 30 minutes or less before surgery, must rely on information from patients' physicians as well as what's on the monitors to assess risks and select anesthesia drugs.
Suyama thought it would make sense to have an in-hospital center that prepared patients for safe surgery and anesthesia. In 2004, he launched the Queen's Anesthesia Preoperative Evaluation Center (APEC). The center has significantly decreased cancellations, earning Queen's a Hospital Quality Service Recognition award from HMSA. APEC evaluates nearly 70 percent of Queen's surgical candidates. Most are evaluated through an initial phone screening, and about 30 to 40 patients each week need additional assessment.
According to Arthur Ushijima, president and CEO of Queen's Health Systems, the APEC program has improved Queen's patients' overall surgery experience. "The program helps minimize potential anesthesia complications by getting to know the patient's individual care needs," he says.
Limm has been using Queen's APEC since it opened. "It's a valuable service for patient safety and convenience," he says. "I don't want anyone to miss something that could have a significant impact on the procedure. APEC gets all the relevant information from patients, their doctors, surgeons and internists."
For more information on Queen's Anesthesia Preoperative Evaluation Center, please call 547-4874 on Oahu or 1 (800) 342-5901, ext. 4874, toll-free from the Neighbor Islands.
