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Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during
Petar Popivanov1, Sohail Bampoe2, Terry Tan3
1Department of Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland ppopivanov@coombe.ie.
Insights
Virtual preoperative anesthetic assessments offer a safe and efficient alternative to in-person visits, reducing patient wait times and cancellations. This study demonstrates the feasibility of telemedicine in anesthetic care during the COVID-19 pandemic.
Area of Science:
- Anesthesiology
- Health Services Research
- Digital Health
Background:
- Preoperative risk assessment is crucial for surgical outcomes.
- COVID-19 restrictions necessitated minimizing in-person hospital visits.
- Telemedicine (TM) showed potential for preoperative anesthetic evaluations.
Purpose of the Study:
- To develop, implement, and evaluate a virtual preoperative anesthetic assessment process.
- To ensure high-quality care while minimizing patient exposure during the pandemic.
Main Methods:
- Utilized a three-step model for improvement and plan-do-study-act (PDSA) cycles.
- Collected data on virtual vs. in-person referrals, assessments, DNA rates, consultation times, and cancellations.
- Conducted service-user and provider experience surveys.
Main Results:
- 50% of 2805 patients underwent virtual assessments.
- Virtual pathway had a significantly lower did-not-attend (DNA) rate (0.4%) compared to in-person (3%).
- Virtual consultations were shorter (19 min) than in-person (31 min), with high user satisfaction despite limited physical examination opportunities.
Conclusions:
- Telemedicine is a feasible and effective method for preoperative anesthetic assessments.
- Virtual assessments can improve efficiency and reduce patient no-shows.
- Further research may explore integrating physical examination components into virtual assessments.
Background:
Preoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions required a careful balance between ensuring best medical practices and maintaining safety by minimising patient face-to-face attendance in the hospital. Based on the successful implementation of telemedicine (TM) in other medical specialties and its feasibility in the preoperative context, this study aimed to develop, implement and evaluate a high-quality virtual preoperative anaesthetic assessment process.
Methods:
The three-step model for improvement was used. The specific, measurable, actionable, relevant, time aim (step 1) and measures for improvement (step 2) were defined at the onset of the project. The plan-do-study-act tool was used for the structured implementation of improvement interventions (step 3) in three phases. Data relating to virtual and in-person referrals, assessments, did-not-attend (DNA) rate, consultation time, day of surgery delays and cancellations, and service-user and provider experience surveys were recorded prospectively.
Results:
A total of 2805 patients were assessed in the preoperative anaesthetic assessment clinic between July 2020 and March 2021. The mean rate of virtual preoperative assessments was 50% (SD ±10) (1390/2805). 0.1% (30/2805) were inappropriately referred on the alternative pathway. The DNA rate was 0.4% (8/1398) and 3% (43/1458) for virtual and in-person pathways, respectively. The mean consultation times for virtual and in-person attendance were 19 (SD ±7) and 31 (SD ±13) min, respectively. There were five same-day surgery cancellations and one delay due to medical reasons. When asked about their experience with the virtual assessment, both service users and providers reported high satisfaction, minimal technical difficulties and shared concerns about limited opportunities for physical examination.
Conclusion:
This is one of the first implementational studies to comprehensively outline the feasibility of TM in preoperative anaesthetic assessment during COVID-19.
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