langcare-pre-op-labs - SKILL.md Agent Skill

name: langcare-pre-op-labs description: > Evaluates preoperative laboratory readiness by checking required labs based on procedure type, patient age, comorbidities, and ASA classification. Identifies missing or expired labs and flags abnormal results that may delay surgery. Use when asked for pre-op labs, surgical clearance labs, preoperative lab checklist, or readiness for surgery assessment.

Preoperative Lab Checklist

When to Use This Skill

Use when a clinician needs to verify that all required preoperative laboratory tests have been completed, are within acceptable timeframes, and have acceptable results for surgical clearance.

Clinical Workflow

Use fhir_read to retrieve Patient demographics (age, gender)
Use fhir_search to pull active Condition resources for comorbidity-based lab requirements
Use fhir_search to pull active MedicationRequest resources for medication-based lab requirements (e.g., anticoagulants require coag studies, digoxin requires level and electrolytes)
Use fhir_search to pull scheduled Procedure or ServiceRequest for the planned surgery to determine procedure type
Determine required labs based on: patient age (>45: ECG, BMP; >65: CBC, CMP, ECG), comorbidities (diabetes: glucose/A1c; cardiac: BNP/troponin; renal: BMP/CrCl; liver: LFTs/coags; anemia: CBC/iron), procedure type (blood loss risk: T&S/CBC; cardiac surgery: full panel), medications (anticoagulants: PT/INR; digoxin: level)
Use fhir_search to pull recent Observation resources (laboratory) and check if required labs are present and within acceptable timeframe (typically 30 days, 7 days for coags on anticoagulants)
Flag: missing labs, expired labs (older than required timeframe), abnormal results that may delay surgery

FHIR Resources

Patient -- Age for age-based requirements
Condition -- Comorbidities driving lab requirements
MedicationRequest -- Medications requiring monitoring
Observation -- Lab results to verify completeness and values
ServiceRequest -- Planned procedure for procedure-specific requirements

FHIR Query Examples

Pull Recent Labs (30 days)

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=laboratory&date=ge[30-days-ago]&_sort=-date&_count=200")

Pull Planned Procedure

fhir_search(resourceType="ServiceRequest", queryParams="patient=[patient-id]&status=active&intent=order&category=387713003")

Clinical Guidelines

ASA Practice Advisory for Preanesthesia Evaluation (2012, reaffirmed)
ACS NSQIP Surgical Risk Calculator inputs
ACC/AHA perioperative cardiovascular evaluation guidelines

Interpretation Guide

Present as a checklist: required lab, status (completed/missing/expired), result, date, and pass/fail
Flag surgical hold criteria: K+ <3.0 or >5.5, Hgb <8 (varies by procedure), platelets <50K for most surgeries, INR >1.5 (unless cardiac surgery), glucose >250, positive pregnancy test
Include pre-op ECG requirement status for patients >45 or with cardiac history
Calculate estimated blood loss risk by procedure type and verify type & screen/crossmatch availability

Safety

Never fabricate clinical data -- only report what FHIR returns
Flag critical/abnormal values immediately
Scope all FHIR queries to the authenticated patient
Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
Present data in clinician-friendly format with reference ranges