All charts for patients coming for surgical procedures at the University of Maryland Medical Center (UMMC) originate in the PREP Center.
About half of all these patients are seen in the PREP Center by our nurse practitioners for a pre-operative history and physical and are also seen by our anesthesiology residents and attendings. 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. This could be an EKG, laboratory testing, chest x-rays or consults from other medical services (such as cardiology).
The other half of patients undergoing procedures at UMMC are chart reviews and “telephone pre-ops”. The attending anesthesiologist reviews all available medical information and calls the patient at home to give and get information regarding the patient's surgical procedure as well as his or her past medical and past anesthetic history.
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.
The staff in the PREP Center consists of clerical staff, clinical technicians, nurses, nurse practitioners, anesthesiology residents and attendings ,as well as medical students and CRNA students.
The patients 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 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.
We also use a web based program called "Emmi" that patients can access online, from home or from the Patient Resource Center or the PREP Center inside the hospital. It is a teaching tool to prepare patients for the risks and benefits of anesthesia and different anesthetic techniques. The pre-operative Patient Questionnaire is also attached to the Emmi program. Patients have the ability to communicate concerns or questions to their anesthesia team through Emmi.
Beatrice Afrangui, M.D.
Medical Director, PREP Center
Assistant Professor of Anesthesiology
Department of Anesthesiology
University of Maryland Medical Center
Phone: (410) 328-6120