ICSI has made a significant format enhancement in our scientific documents. All scientific documents (excluding Order Sets) now have “interactive” capability that allows a user to click on various links in the document and easily navigate from one area to another. For example, you can click on an algorithm box (those denoted with blue text and those that refer to other algorithm boxes) and link directly to the supporting annotation.

A tip for quickly going back and forth within the document:
Go to View, Toolbars, More Tools, Page Navigation, Previous View.
This should give you a back arrow tool that will allow you to go back and forth between views easily.

Note: The interactive links within ICSI PDF guidelines may not work on some mobile devices. However, the GoodReader App (and possibly some other "reader" applications) will allow anyone to open ICSI interactive PDF Guidelines on their mobile device and utilize most of the interactive capabilities.

Scope and Target Population:
The guideline describes appropriate evaluation for elective, non-high-risk operative procedures for adult and pediatric patients. Pediatric patients for whom this guideline is intended are those between the ages of 2 and 15 years. Patients over age 15 are considered adults for the purposes of this guideline.

Aims

1. Increase the percentage of complete preoperative history and physical examinations obtained for patients two years of age and older undergoing elective, non-high-risk surgery and eliminate diagnostic tests performed without clinical indications.
   
2. Increase the percentage of patients two years of age and older undergoing elective, non-high-risk surgery who receive appropriate management of stable comorbidities prior to procedure.
   
3. Eliminate canceled or delayed elective, non-high-risk surgical procedures for patients two years of age and older due to incomplete preoperative history and physical examination and ineffective communication between clinicians.
   

Clinical Highlights

• Provide a comprehensive preoperative basic health assessment for all patients undergoing a diagnostic or therapeutic procedure as defined in the guideline.
  
• Most laboratory and diagnostic tests including electrocardiograms are not necessary with routine procedures unless a specific indication is present.
  
• Patient education and instruction strongly influence perioperative outcomes (e.g., medication management, apnea screening, nicotine cessation and surgical site infection).

Additional Background:
Most non-high-risk patients having elective surgery do not require routine laboratory and diagnostic testing including electrocardiograms unless a specific indication is present. This guideline acknowledges this observation, and stresses a basic history and physical examination as the key events in a preoperative assessment. Further testing is required for certain procedures, abnormal findings and age-related risks.

It is understood that the scope of this document is related to the period of time prior to the patient arriving at the hospital for surgery; however, it is recognized that the content and management of patients preparing for surgery preoperatively is also closely associated with the content and management of patients in the perioperative period.