Workflow: Preparing a Pre-Operative Cardiac Risk Assessment Letter

Pre-operative cardiac risk assessment letters need to communicate a clinical opinion clearly and in a format the receiving surgical team can act on. This workflow uses an AI tool to draft the structure and prose from your clinical summary.

1. Clarify the clinical question before you start

   Before opening the tool, be clear about what the surgical team is asking and what you are providing. Are they asking for a general cardiac risk opinion? A specific assessment of fitness for a particular procedure? A recommendation about perioperative management? The letter should answer the question they asked. Write down the surgical question in one sentence before you open the tool.

2. Prepare your anonymised clinical summary

   Write a brief bullet-point summary of the patient's relevant cardiac history: diagnoses, current medications (by class), recent investigations and their results, functional capacity, and any specific cardiac concerns relevant to the planned surgery. Remove all identifying information.

3. Open the tool and specify the letter format

   Open your AI tool and type: "You are helping a cardiologist draft a pre-operative cardiac assessment letter to a surgical team. I will provide anonymised clinical bullet points. Draft a structured letter with these headings: Reason for Assessment, Relevant Cardiac History, Current Investigations, Clinical Assessment, Recommendations. Do not include specific drug doses. Do not include clinical risk scores — I will add my own assessment."

4. Provide the clinical content

   Paste your bullet points. The tool will produce a structured draft. The Clinical Assessment and Recommendations sections will be placeholder frameworks — the tool correctly cannot generate your clinical opinion. These are the sections you will write yourself.

5. Write the clinical assessment and recommendations yourself

   Delete the tool's placeholder content in the Clinical Assessment and Recommendations sections. Write these yourself. This is the clinical opinion that only you can provide — it should reflect your assessment of the patient's cardiac risk in the context of the planned procedure, the perioperative monitoring you recommend, and any specific management considerations. Do not delegate this to the tool.

6. Review the investigations section for accuracy

   Check that every investigation result mentioned in the draft came from your bullet points and is accurate. The tool should not add investigation values you did not provide. If it has, remove them and replace with the correct values.

7. Check the tone for the receiving surgical team

   Pre-operative assessment letters are read by surgeons and anaesthetists who need to know what to do. Check the recommendations section is clear and actionable — not hedged or vague. If your clinical assessment is that the patient is suitable for surgery with standard monitoring, say that clearly. If there are specific perioperative concerns, state them specifically.

8. Add identifying details and complete the letter

   Transfer the draft into your clinical system. Add the patient's identifying information, the surgical team's details, the planned procedure, and the date of your assessment. Review the complete letter and sign.

What this means for you

A well-structured pre-operative cardiac assessment letter reduces delays to surgery by giving the surgical team a clear, complete answer to the clinical question they asked. The tool handles the structural work of organising the history and investigations. Your clinical judgement — the assessment and recommendations — is irreplaceable and must be written by you.

When not to use this workflow

For patients with complex cardiac conditions where the pre-operative assessment involves a nuanced risk-benefit discussion — significant aortic stenosis, recent acute coronary syndrome, decompensated heart failure — the clinical assessment section requires particularly careful writing. In those cases, use the tool for the history and investigations framework only, and give the assessment section full individual attention.

Remember: AI is a helpful assistant, not a clinician. You make the call.