Pre-Op (POMA)

ICU POMA POLICY

MICU / SICU / NSICU: Intensivists complete POMAs

CTICU: Hospitalist (or other consult physician) does non-cardiac cases.  

Note: per Erin Gabriel (Hospitalist Director of Pre-Op Medicine and Consult Service),  we are NOT to write note stating the pt does not need a POMA as they are ASA 1 or 2.  The surgeon and anesthesiologist are responsible for designating the ASA class.  See email text below:

Hi everyone,

I was recently made aware that we've been getting a lot of requests from Neurosurgery (and possibly other services I'm not aware of) asking us to document in the chart that a patient is an ASA 2 and therefore doesn't need a POMA. We should not be writing these notes - this is not part of our role, and opens us up to liability based on only a brief chart review rather than a full assessment of the patient.

According to the POMA guidelines, the surgeon designates the ASA class when the surgery is booked, but ultimately the ASA class is determined by the anesthesiologist. Good communication is key to making sure these patients are well cared for. If based on what the surgeon tells us and a brief chart review, the patient seems to be an ASA 2, please ask if they have any concerns about the patient's health or periop management. We can offer a medical consult if they are unsure how to manage a chronic condition. Or if the patient is borderline between an ASA 2 and 3, please err on the side of assuming they are a 3 and completing the POMA.

Ultimately if there is still any disagreement, the consulting surgery team should consult the anesthesiologist on call to help finalize the patient's ASA status.

Let me know directly if you have any questions,

thanks,

Erin