Preop Eval vs ManageAnticoag

Preop Eval organizes and presents much of the guidance that one needs in order to evaluate and prepare adult patients for non-cardiac surgery. It is based upon the guidelines on this topic from the American College of Cardiology, the European Society of Anaesthesiology, the American Society of Anesthesiologists, the Institute for Clinical Systems Improvement, the American College of Chest Physicians, and more (full references in the app). The app contains 1 algorithm and 3 resources: the cardiac evaluation algorithm, guidance on starting and stopping key medications in the perioperative period, guidance on timing of surgery after cardiac events, and guidance on preoperative testing. It also contains a review of preoperative evaluation mainly for students and residents. The app addresses such common questions as: - who needs bloodwork before surgery? - who needs an EKG or a CXR? - how do I handle patients on warfarin, clopidogrel, and DOAC's? - which patients need adjustment of perioperative insulin and diabetic meds, and how? - which active cardiac conditions preclude surgery? - how long after MI or stent should a patient wait before surgery? - are there adjustments to make on psych meds, rheumatologic meds, ACE's and ARB's? This app is written and intended for practicing physicians like internists, family physicians, and hospitalists; for resident physician trainees; and for medical students. In addition to being a reference, the algorithm is written to be a teaching tool by not just delivering an answer, but instead walking a physician through the evaluation process so that one learns that process along the way. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.

This clinical decision support app helps clinicians navigate periprocedural planning and bleed management scenarios for patients on oral anticoagulants (OAC). The app is comprised of three tools to support the following clinical decisions: • Assessing whether and how to interrupt and bridge anticoagulation • Managing acute bleeds, including the suggested use of reversal agents • Determining whether and how anticoagulation should be restarted A clinician can use the app by: • Selecting which tool best applies to the patient scenario and following these steps: o Enter patient details regarding bleed and stroke risk factors as prompted in the selected tool o View individualized guidance on the advice screen o Email a summary of the advice • Use the Quick Reference section to access supporting information and details such as "Guidance for Administering Reversal Agents” and “Components of the Clinician-Patient Discussion." Information in the app is derived from ACC’s Expert Consensus Decision Pathways on Periprocedural Management and Bleed Management in patients with AFib. The information and recommendations in this clinical decision support tool are meant to support clinical decision making. The app is not meant to and should not replace clinical judgement. The healthcare provider is in control of all diagnoses and other clinical decisions.