Minor+procedures+clinic

Minor Procedures Clinic
//These guidelines for referrals were submitted by Kim Haglund, surgical registrar, September 2008, edited 5.13.11 by cfarnitano. Updated 12/13/12 by Michel Sam.//

Minor procedures clinic is run in **Martinez Tuesday AM and Wed PM.** As of 1/1/13, it will also be ran in **WCHC on Tues PM**.

1. Refer patients through Ambulatory Referral to Minor Procedures in Epic and they will be scheduled in the Tues or Weds clinic. Patients with a PCP in West County (WCHC or NRC) will be scheduled at WCHC on Tues PM. If you have a patient that wants to go to WCHC but has an official PCP listed elsewhere, please indicate in the referral that they want to go to WCHC, otherwise they will be sent to MTZ. 2. Unfortunately, general surgery clinic in RHC and PHC is **not** a substitute for minor procedure clinic. While we can do some //limited// procedural stuff at PHC and RHC like needle biopsies, small I&Ds, limited wound debridement, etc, we do not have nearly the level of staff or equipment support that’s available at MTZ minor procedures room.

3. Appropriate procedures for minor procedures
 * Excisional biopsies of basal cell or squamous cell cancers
 * Initial excisional biopsy to evaluate for possible melanoma (or send to plastics if you wish and can get pt in promptly)
 * Lipoma removal (bigger than 10cm or anything that has potential to develop a seroma or needs to be done in the OR should be referred to plastics or gen surgery)
 * Sebaceous cyst removal
 * Ganglion cyst removal from dorsal hand/foot
 * Foreign body (e.g. bullet fragments, glass, splinters) from limbs or subQ of trunk
 * Port-a-cath removal
 * for facial/cranium lesions in delicate areas (tip of nose, periorbital, large lesions that might require a flap), consider referring them to plastics to save everyone involved some time and frustration (including the patient...). If in doubt, you can always get in touch with Cominos, Solomon, or Sam.

-**No minors in minors**! We only use local anesthesia in minors, so do not send any small children. Teenagers that can sit still are fine.

4. If you are in MTZ and want to do the procedure yourself, get in touch with Evelyn Sunga (LVN in MTZ) to set up a time for your patient. Friday AM in MTZ is not staffed by a particular registrar, it is a good time to do procedures yourself (if you have privileges). If you don’t have privileges but want to learn/get proctored, page one of the surgery registrars (**in advance**) to see if they can help you. Please do not schedule into a Friday minor procedure clinic unless you are planning to do yourself, or you have already discussed with a registrar who has agreed to do the procedure that day. Everyone hates sending patients home without what they thought they were going to get done, but if we are rounding with a resident on 10 patients and get called without warning from the Minor Procedure nurse at 11:00 am on a Friday about a patient we’ve never heard of, it may not be possible to do the procedure.

5. If you are in West County and want to do the procedure yourself, get in touch with Michel Sam in advance.