General Anesthesia Imaging-Healthcare Professionals/Providers

General Anesthesia Imaging: Ordering Provider Helpful Hints

Elective general anesthesia (GA) imaging procedures may be ordered on patients 4 months of age or older per recommendations by the Children’s of Alabama (COA) Anesthesiologists (Pediatric Anesthesia Associates, PC). GA imaging procedures must be scheduled through Surgery Scheduling via a Surgery Scheduling request form and require an actual order from the ordering provider and up-to-date history & physical. The following GA imaging “ordering provider helpful hints” were developed to assist offices when scheduling GA imaging procedures at COA. The guidelines provide information regarding what is required to be completed, coordinated or submitted by the ordering provider or their office prior to the day of a patient’s GA imaging scan.

1. SCHEDULING A GA IMAGING SCAN
   GA IMAGING SURGERY SCHEDULING REQUEST FORMS
   1. Fill out a Surgery Scheduling GA imaging request via a printable or editable electronic form which may be obtained by contacting Surgery Scheduling 205-638-9777.
   2. Provide 2 preferred scan dates on the request.
   3. Specify if the patient has any implantable metallic devices.  
      EX:  programmable shunt, cochlear implant, vagal nerve stimulator, dental braces/hardware, etc.
   4. Fax the GA imaging Surgery Scheduling request form directly to Surgery Scheduling 205-638-5292.
   5. Your office will receive a “form received” return fax from Surgery Scheduling within 24 business hours.  If you do not receive a “form received” fax, please contact Surgery Scheduling 205-638-9777 regarding your submission.  “Form received” confirmations verify that the actual request form has been received by Surgery Scheduling, not that the case has been posted on the surgery schedule.
2. REQUIRED PAPERWORK
   
   1. HISTORY & PHYSICAL (H&P): History and Physical Form (PDF)
      1. H&Ps MUST be completed within 30 calendar days prior to the scan.  Having an up-to-date H&P is a Joint Commission, Centers for Medicare and Medicaid Services and COA policy requirement in order to perform GA imaging procedures.  Failure to have an up-to-date and/or readily available copy of the patient’s pre-scan H&P could potentially result in case cancellation.
      2. H&Ps may be completed by the ordering provider, primary care provider or other specialty care provider qualified/licensed to perform patient medical H&Ps.
      3. H&Ps must be signed, dated & timed by the medical provider completing the H&P form and contain the patient’s legal name and date of birth as required identifiers.  Anesthesia Pre-Admit Screening Service (APASS) also recommends that the ordering provider’s name, date of scan and COA medical record number (if available) is provided.
      4. Completed H&Ps may be submitted via APASS fax 205-638-5242 or email apass@childrensal.org prior to the date of the scan.
      5. Please have the parent/legal guardian bring an additional copy of the H&P on the day of the scan.
   2. IMAGING ORDER:
      1. The ordering provider must submit an order for the Imaging Department to perform the scan.
      2. If the ordering provider completes the order section of the GA imaging Surgery Scheduling request form, this may be used in lieu of providing an additional imaging order as long as it is dated, timed and signed by the ordering provider.
      3. Orders sheets must contain the patient’s legal name and date of birth as required identifiers.  APASS also recommends that the ordering provider’s name, date of scan and COA medical record number (if available) is provided.
3. ANESTHESIA CLEARANCE
   APASS Questionnaires: APASS Questionnaire (PDF)
   1. The patient’s parent/legal guardian should complete an APASS questionnaire and submit the questionnaire to APASS at least 3 business days prior to the scan.  This allows adequate time for review and additional follow-up that may be required to clear the patient for anesthesia.
   2. Questionnaires may be faxed to APASS 205-638-5242 or completed online www.onlinepreop.com or www.childrensal.org/apass.
4. PATIENT INSTRUCTIONS
   
   1. The ordering provider’s office is responsible for initially contacting the parent/legal guardian to inform them of the official scan date.
   2. An Imaging PACU nurse will set the case line up for all GA imaging procedures for the next business day.
   3. Imaging PACU nurses will notify the parent/legal guardians of the patient’s arrival time and give nothing by mouth (NPO) instructions.
5. MAGNETIC RESONANCE IMAGING (MRI) PATIENTS UNDER 4 MONTHS OF AGE
   
   1. Ordering providers should refrain from ordering routine, baseline GA MRIs on patients under 4 months old unless medically urgent.
   2. It is the ordering provider or the ordering provider office’s responsibility to contact an Anesthesiologist to obtain approval to post a medically urgent GA MRI for a patient under 4 months old.
   3. The ordering provider may contact the APASS office 205-638-6235 for Anesthesiologist contact information.
   4. The ordering provider’s office must write the name of the Anesthesiologist that approved posting a medically urgent GA MRI for a patient under 4 months of age on the actual GA MRI Surgery Scheduling request form in the section labeled “MRI Under 4 months or Combo Case Approval”. This approval MUST be done prior to submitting the form to Surgery Scheduling.
   5. Surgery Scheduling will post in the surgery scheduling comments which Anesthesiologist approved posting the case.
6. GA IMAGING COMBINATION CASES
   
   1. It is the ordering provider or the ordering provider office’s responsibility to contact an Anesthesiologist to obtain approval to post a GA imaging combination case.
   2. The ordering provider may contact the APASS office 205-638-6235 for Anesthesiologist contact information.
   3. The ordering provider’s office must write the name of the Anesthesiologist that approved posting a GA imaging combination case on the actual Surgery Scheduling request form in the section labeled “MRI Under 4 months or Combo Case Approval”. This approval MUST be done prior to submitting the form to Surgery Scheduling.
   4. Surgery Scheduling will post in the surgery scheduling comments which Anesthesiologist approved posting the case.
   5. The surgeon/ordering provider’s office is responsible for initially contacting the parent/legal guardian to inform them that the patient could possibly receive 2 separate anesthetics on the same day if the GA imaging scan is combined with another GA procedure/surgery.
7. LABORATORY SPECIMENS
   
   1. The ordering provider should refrain from requesting lab specimen collection while the patient is under anesthesia during the GA imaging scan.
   2. Lab specimens requested by the ordering provider, primary care provider or other specialists (if not medically necessary for the GA imaging anesthesia plan of care) will need to be collected after the patient’s discharge from the Imaging department by COA’s Laboratory Department.
   3. COA Laboratory requires an available order at the time of patient registration in the Referred Testing Department and specimens are collected at one of the COA Laboratory sites located throughout the hospital.

Helpful Forms

APASS Questionnaire (PDF)

One Day Surgery Booklet (PDF)

History and Physical Form (PDF)