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Pre-Operative Care Clinic Referral Guidelines

The Pre-operative Care Clinic (POCC) is a dedicated team of health professionals that help prepare patientsfor surgery at Children’s National. Our patients range from neonates to adult patients with congenital diseases. Our care team includes pediatric anesthesiologists, hospitalist based pediatricians, nurse practitionersand nurses.

For patients with complex medical histories, disabilities or having extensive surgery, we have found we canbest care for them with a visit to our POCC clinic several days to several weeks ahead of the planned surgery.We work with these patients and families to create a thorough care plan to optimize their health before surgery,and coordinate care between medical and surgical services. Although many of our patients do have significantmedical concerns, we also see patients who have family members with complications with anesthesia or thosewho have concerns and questions, and would like to meet with an anesthesiologist ahead of the day of surgery.

Download the History and Physical form.

Personal or Family History of Anesthesia Complications

  • Referral When: Parents desire to meet with an anesthesiologist ahead of the day of surgery, or has family history suggestive of malignant hyperthermia (relative with cardiac arrest, high fever, muscle rigidity around the time of surgery) or other serious complication with anesthesia.
  • Data Needed: Good history – possibly anesthesia records from another hospital.

History of Difficult Intubation in the Patient

  • Referral When: There is a patient history of difficult intubation with previous surgery.
  • Data Needed: Anesthesia records from past surgeries.

Patient Follows with Multiple Medical Specialists

  • Initial Work-Up: Our nursing team will acquire notes from recent visits and tests, if they can be sent from your office it can be helpful.
  • Referral When: Often the surgeon performing the procedure may inform the POCC, however you may be asked for authorization for insurance purposes. Additionally you may recommend or refer your patients to the POCC directly.
  • Data Needed: Note from your last visit with child (other records can be helpful but not necessary).

Patient Scheduled for Surgery or Procedure under Anesthesia with Certain Medical Conditions

Heart disease, pulmonary hypertension, cystic fibrosis, home oxygen or ventilator, muscular dystrophy, diabetes mellitus, diabetes insipidus, renal failure, hepatic failure or intestinal disorder, bleeding disorder, metabolic disorder or any other patient who you feel may benefit

  • Referral When: Surgery is planned in a child with a medically complex condition where they follow multiple specialists. Often the surgeon performing the procedure will inform the POCC, however you may be asked for authorization for insurance purposes. Additionally you may recommend or refer your patients to the POCC directly. 


Patients who require sedation for a MRI will receive a deep sedation comparable to a general anesthesia under the care of an anesthesiologist.

  • Referral When: Patients who are to be scheduled for a MRI that will require sedation and have the following conditions: 
    • Complex or cyanotic cardiac disease 
    • Significant pulmonary disease including oxygen dependent 
    • Mitochondrial or metabolic disorder 
    • Muscular dystrophy 
    • Difficult airway or anesthesia difficulty – particularly at another institution  

Should be referred to the POCC clinic to be seen before MRI.

Download a pdf of these guidelines.