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Pediatric Preanesthesia Assessment Electronic Triage Tool: Implementation, Quality Improvement, and Retrospective
Natasha Mills1,2, Everan Michalchyshyn1, Megan Parry1
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada.
Insights
A new electronic triage tool (PAC-Q) streamlines pediatric preanesthesia assessment, improving screening completion rates and patient satisfaction. This digital approach enhances efficiency in perioperative care.
Area of Science:
- Anesthesiology
- Health Informatics
- Quality Improvement
Background:
- Preanesthesia assessment is crucial but resource-intensive, with variable pediatric screening.
- Electronic health records (EHRs) offer potential for standardization.
- Current pediatric perioperative screening lacks consistency.
Purpose of the Study:
- To develop and implement an electronic preanesthesia triage tool.
- Integrate a patient-administered electronic triage questionnaire (PAC-Q) with the Epic EHR.
- Streamline pediatric preanesthesia assessment processes.
Main Methods:
- Utilized a quality-improvement framework to create the PAC-Q.
- Adapted Epic's questionnaire into a 28-item PAC-Q distributed via MyChart.
- Weighted responses to generate a triage score for patient routing to RN, NP, or MD.
Main Results:
- 3993 patients completed the PAC-Q by August 31, 2025.
- Significant increase in completed preanesthesia assessments from 71.3% to 83.8%.
- High patient and provider satisfaction reported, with reduced administrative burden.
Conclusions:
- The PAC-Q is a scalable, patient-centered digital tool for standardizing pediatric preanesthesia triage.
- The tool reduces unnecessary visits and improves screening uptake.
- Adaptable to various perioperative settings to enhance efficiency and patient experience.
Background:
Preanesthesia assessment is essential but resource-intensive. Electronic health records (EHRs) are widespread, yet pediatric perioperative screening remains variable.
Objective:
To develop and implement a preanesthesia triage tool based on patient-administered electronic triage questionnaire (PAC-Q) integrated with the Epic EHR to streamline pediatric preanesthesia assessment.
Methods:
Using a quality-improvement framework, we created a preanesthesia triage tool that includes an adapted version of Epic's foundation questionnaire to form a 28-item PAC-Q distributed via MyChart. Responses were weighted (0, 1, or 100) to generate a triage score that, together with surgical risk, routed patients to an RN, NP, or MD for preanesthesia assessment. Implementation was staggered across surgical services. Adoption and outcomes were monitored via Epic dashboards and Power BI.
Results:
By August 31, 2025, 3993 patients completed the PAC-Q. Of these, 53.7% (2144/3993) were triaged to an RN, 12.3% (492/3993) to an NP, and 6.8% (272/3993) to an MD; 27.1% (1083/3993) were cleared by chart review without further consultation. Comparing April-June 2023 with April-June 2025, completed preanesthesia assessments increased from 71.3% (1182/1659) to 83.8% (1510/1802) (χ2 = 78.70, p < 0.0001). In otolaryngology, completion rose from 22.9% (65/284) to 82.7% (230/278) (χ2 = 199.37, p < 0.0001). Providers and families reported high satisfaction and reductions in administrative burden.
Conclusions:
The PAC-Q is a scalable, patient-centered digital tool that standardizes pediatric preanesthesia triage, reduces unnecessary visits, and improves screening uptake. It can be adapted to diverse perioperative settings to enhance efficiency and patient experience.
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