TRIAGE SCREENING QUESTIONNAIRE (6-INPUTS)
1 · ASA Physical Status
2 · Surgery Risk Category (NYP P450)
Low: cataract, vascular access, distal extremity
Low–Mod: scope, hernia, arthroscopy/ACL, chole/appy, thyroid, cardiac cath, pacemaker
Mod–High: intraperitoneal, prostate, hysterectomy, joint replacement, nephrectomy, bariatric
High: cardiac, thoracic, aortic/major vascular, intracranial, multi-level spine, transplant
Low–Mod: scope, hernia, arthroscopy/ACL, chole/appy, thyroid, cardiac cath, pacemaker
Mod–High: intraperitoneal, prostate, hysterectomy, joint replacement, nephrectomy, bariatric
High: cardiac, thoracic, aortic/major vascular, intracranial, multi-level spine, transplant
3 · Functional Capacity
4 · Unstable/Severe Comorbidity?
For patients with recent MI, heart failure, valvular disease, pulmonary HTN, ESRD, or COPD/home oxygen.
5 · Difficult Airway or Prior Anesthesia Concerns?
For patient with known/suspected difficult airway or a prior serious anesthesia complication.
6 · Needs Perioperative Medication or Logistical Planning?
For patients requiring anticoagulant/antiplatelet, SGLT2i/GLP-1, device management, or an assessment barrier (poor historian, no reliable med list, interpreter, no caregiver).
RECOMMENDATION FOR ESCALATION
Awaiting inputs
Answer the six items to generate a starting-point recommendation.
Rationale
No inputs selected yet.
This tool is intended for clinical workflow support and does not replace clinician judgment or institutional policy. It suggests a testing pathway at booking; it does not clear any patient for surgery.
RECOMMENDED LABS PER NYP-CORNELL P450
Awaiting inputs
ASA (patient health) x Surgical Risk (per NYP-P450)
Recommended
Select ASA and surgery risk category (inputs 1 & 2)
NEURO, CARDIAC, PULM CONSIDERATIONS
No additional considerations.
Source & reference: NYP Policy P450 — Pre-Procedural Evaluation Requirements ↗