[Online versus non-standard face to face preoperative assessment: cost effectiveness]

We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests.

We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods.

5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn't differ between 2008 (2,3%) and 2010 (1.75%).

This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate.