Anesthesia Preoperative Evaluation Clinic Research Articles

Implementation and Impact of Universal Preprocedure Testing of Patients for COVID-19 Before Endoscopy

Implementation and Impact of Universal Preprocedure Testing of Patients for COVID-19 Before Endoscopy

COVID-19 Preoperative Assessment and Testing: From Surge to Recovery.

COVID-19 Preoperative Assessment and Testing: From Surge to Recovery.

Experience of operating an anesthesia preoperative evaluation clinic in South Korea: An observational study of surgeons' satisfaction.

The benefits of an anesthesia pre-operative evaluation clinic (APEC) based on outpatients are well described in previous literatures. In the majority of hospitals in South Korea, preoperative anesthetic evaluation for surgical patients is limited to hospitalized patients on the day before surgery. Thus, we would like to share our institutional experience of implementing an APEC based on outpatients and report on the attitudes and satisfaction of the medical staff (surgeons).A 2-page survey was distributed to all specialists and resident physicians involved in surgery at a single university hospital during a 3-month period. A 5-point Likert scale of agreement and an open-ended question examined perceptions of APEC. A total of 123 questionnaires were distributed and 67 surveys were collected over a 3-month period with a 54.5% collection rate. The surgeons’ perceptions of APEC are summarized in Figure 1. It is difficult to state the tendency of surgeons’ perception of the clinic, including workload, patient satisfaction, patient safety, necessity, cost-effectiveness, and efficiency through this survey. However, many surgeons chose to comment on suggestions to improve the quality of the APEC through the open-ended question.The surgeons’ attitude and satisfaction to anesthetic services including APEC are an important component of achieving quality improvement. Although it is difficult to state the tendency of surgeons’ perception of the clinic, including workload, patient satisfaction, patient safety, necessity, cost-effectiveness, and efficiency through this survey, continuous assessment and feedback may improve efficiency of the APEC and affect patient perception as well.

A novel anesthesiologist-led multidisciplinary model for evaluating high-risk surgical patients at a comprehensive cancer center.

The objective of this retrospective analysis was to describe the development and implementation of an anesthesiologist-led multidisciplinary committee to evaluate high-risk surgical patients in order to improve surgical appropriateness. The study was conducted in an anesthesia preoperative evaluation clinic at an academic comprehensive cancer center. One hundred sixty-seven high-risk surgical patients with cancer-related diagnoses were evaluated and discussed at a High-Risk Committee (HRC) meeting to determine surgical appropriateness and optimize perioperative care. The HRC is an anesthesiologist-led model for multidisciplinary review of high-risk patients developed at Roswell Park Comprehensive Cancer Center. The group of high-risk patients in which surgery was not performed had, on average, a greater percentage of hypertension, smoking history, dyspnea, heart failure, chronic obstructive pulmonary disease, diabetes, renal failure, and sleep apnea than the group in whom surgery was performed. Only one of 107 high-risk patients who had surgery died within the first 30 days after surgery. A smaller percentage of patients died in the group that had surgery versus the group in which surgery was canceled. For all patients discussed by the HRC, the mortality was less than 2% within the first 30 days after the HRC.

Anesthesia preoperative evaluation clinic (APEC) restructuring plan for improving the quality of surgical patient flow

Introduction: Anesthesia preoperative evaluation clinics (APECs) are useful for high-risk surgical patient care, as they improve perioperative outcomes and optimize patient care flow. At Hospital de Clínicas de Porto Alegre, APEC assesses 20% of all patients undergoing surgery, showing the importance of implementing strategies to improve outpatient clinic efficiency by prioritizing high-risk patients.Methods: Using a specific quality management tool for process improvement (PDCA, which stands for Plan/Do/Check/Act), new protocols were developed for patient referral and preoperative evaluation. Clinical staff was trained in the new routines, and an electronic screening system for patient referral was adopted. Data on patient profiles, referring surgical specialties, type of surgery, and waiting times for appointment and surgical procedure were compared before and after the intervention.Results: APEC performed 1,286 appointments between 2013 and 2016, including 733 pre-intervention and 553 post-intervention. There was a significant decrease in the appointments for patients undergoing minor surgery and an increase in the appointments for those undergoing major surgery. The waiting time between referral to APEC and first APEC appointment reduced from 46 to 16 days. In addition, there was an increase in vascular, orthopedic, and urology referrals, as well as a reduction in ophthalmology and general surgery referrals. Conclusion: The PDCA method assisted with conceiving, executing, and monitoring the implemented strategies for changing the profile of patients evaluated at APEC. The major challenge is to measure the long-term impact of this intervention and expand care through specific strategies for surgical specialties and procedures. KEYWORDS: Preanesthesia evaluation; preoperative evaluation; preoperative stratification; risk stratification

IT-Enabled Support for Anesthesia Preoperative Evaluation Clinics

In hospitals, the anesthesia preoperative evaluation clinic helps physicians and patients estimate the risks of scheduled surgical procedures and prepare better plans. Information systems can support these assessments, but most such systems in hospitals focus primarily on displaying and storing patient records. The authors use a three-tier architecture to develop a computerized clinical procedure system with embedded medical guidelines and risk-estimating algorithms to facilitate anesthetists' risk factor assessment. The system was tested in the anesthesia department of a major hospital in Taiwan and was found to be generally accepted by anesthetists.

Organization of an anaesthesia preoperative evaluation clinic - The Anaesthesia/Patient Blood Management Clinic: one Model

The anesthesia preoperative evaluation has been developed in recent years in a centralized clinic, that can be visited by the majority of patients, in order to evaluate and obtain patient's consent for anesthesia. In the current article, the organization and structure of such a central anesthesia preoperative evaluation clinic in the Department of Anesthesia, Intensive Care and Pain Medicine at the University Hospital of Muenster, is described. Besides the central preoperative evaluation clinic, 3 clinics are localized in separate buildings and preoperative visits have to be completed in special scenarios on the wards, too. A pharmaceutical evaluation for patient's medication and the patient blood management have been integrated into the anesthesia preoperative evaluation clinic. Processes are explained and current numbers of patients are mentioned.

Webbasierte Anästhesieanamnese – Patienteninterview zur Erfassung des anästhesiologischen Risikoprofils

At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has potential advantages for both patient and anesthesiologist, not least due to a higher patient safety.

A Structured Educational Curriculum for Residents in the Anesthesia Preoperative Evaluation Clinic

Background: Less than 50% of anesthesia residency programs implement a structured educational curriculum in preanesthesia evaluation for residents. It is unclear whether residents’ knowledge base increases after a structured educational curriculum. We hypothesized that residents’ knowledge base in preanesthesia evaluation would increase after a structured educational curriculum in the Anesthesia Preoperative Evaluation Clinic (APEC). Description: To evaluate this, seventy-six anesthesia residents were assigned to a two-week rotation in APEC with a structured curriculum in preanesthesia evaluation. The anesthesia residents were tested before (pretest) and after (posttest) the APEC rotation. Residents completed a post-rotation questionnaire to evaluate the curriculum. Evaluation: Posttest mean scores were higher than those of the pretest (p<0.05) except for CXR interpretation. Residents evaluated the curriculum and gave a score of 4/5 for perceived achievement of curricular goals for increasing knowledge. Conclusions: A structured curriculum in preoperative evaluation increases anesthesia residents’ knowledge base, except for CXR interpretation.

Evaluation and implications of natural product use in preoperative patients: a retrospective review

BackgroundMedication Reconciliation and Medication Safety are two themes emphasized in a variety of healthcare organizations. As a result, health care facilities have established methods for obtaining a patient's medication history. However, these methods may vary among institutions or even among the health care professionals in a single institution, and studies have shown that patients are reluctant to disclose their complementary and alternative medicine use to any health care professional. This lack of disclosure is important in surgical patients because of potential herbal interactions with medications and drugs used during the surgical procedure; and the potential for adverse reactions including effects on coagulation, blood pressure, sedation, electrolytes or diuresis. Therefore, the objectives of this study are to identify patterns of natural product use, to identify potential complications among patients scheduled for surgery, to improve existing medication reconciliation efforts, and to develop discontinuation guidelines for the use of these products prior to surgery.MethodsA retrospective review of surgery patients presenting to the Anesthesia Preoperative Evaluation Clinic (APEC) at the University of Kansas Hospital was conducted to identify the prevalence of natural product use. The following data was collected: patient age; gender; allergy information; date of medication history; number of days prior to surgery; source of medication history; credentials of person obtaining the history; number and name of prescription medications, over-the-counter medications and natural products; and natural product dosage. Following the collection of data and analysis of the most common natural products used, possible complications and interactions were identified, and a protocol regarding the pre-operative use of natural products was developed and implemented.ResultsApproximately one-fourth of patients seen in the APEC indicated the use of natural products. Patients taking natural products were significantly older, were more likely to undergo cardiac or chest surgery, and were more likely to be taking more prescription and non-prescription medications (all p < 0.001).ConclusionBased on the results of this study, it is concluded that there is a need for established guidelines regarding discontinuation of selected natural products prior to surgery and further education is needed concerning the perioperative implications of natural products.

A Statistical Analysis of the Patients in Anesthesia Preoperative Evaluation Clinic

Background: Inadequate preoperative evaluation leads to delay or cancellation of elective surgery. To minimize this problem, we launched an anesthesia preoperative evaluation clinic. We analyzed major causes of referral, requested departments and distribution of age to make guidelines of management and laboratory tests. Methods: The data was collected based on 6,902 patients referred to the anesthesia preoperative evaluation clinic from August 1997 to February 2002. The number of patients each year, distribution of sex, age, requested departments and clinical causes of referral were analyzed retrospectively. Results: The sex ratio (M/F) was 42：58. Twenty-three percent of the patients were in their 7th decade. Obstetrics and gynecology (24.3%), general surgery (20.7%), and orthopedic surgery (15.4%) were the main requested departments. Major causes of referral were cardiovascular problems (27.5%) and pulmonary problems (21.0%). Irrespective of age and department, the most common consultations were related to cardiovascular or pulmonary problems. Nineteen percent of patients had more than two problems that included diabetes mellitus and hypertension. Conclusions: We concluded that increases in the number of referral patients and making guidelines related to cardiovascular and pulmonary problems will contribute to reduce delay or cancellation of elective surgery.

Economic aspects of an anesthesia preoperative evaluation clinic

Studies continue to demonstrate that preoperative evaluation clinics help to prepare patients for surgery in a manner that minimizes cost and optimizes outcomes. These clinics are becoming common in both teaching and community hospitals. Many full service preoperative assessment clinics utilize specially trained nurses who are under the direction of an anesthesiologist. These clinics are associated with favorable outcomes, dramatic decreases in preoperative testing, infrequent subspecialty consultation and shorter lengths of stay. The current literature is reviewed and organizational and clinical changes that improve efficiency and patient care are highlighted.

Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital

Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital

Development and Effectiveness of an Anesthesia Preoperative Evaluation Clinic in a Teaching Hospital

Development and Effectiveness of an Anesthesia Preoperative Evaluation Clinic in a Teaching Hospital

Reply

Assistant Professor of Anesthesia, Stanford University School of Medicine, Medical Director, Anesthesia, Preoperative Evaluation Clinic, Stanford University Hospital, Stanford, California 94305–5115.In Reply:-Several authors have addressed, in correspondence to Anesthesiology and in personal communications to the author, issues of support, concerns, and questions regarding my recent article. [1]The primary focus of this article was to communicate the imperative need at Stanford University Hospital to change the manner and focus of the anesthesia preoperative system, and to report the results of two cost-effective outcome studies.National health care has entered an era of rapid change, transformation, and evolution. The competitiveness and complexity of these changes place an increasing emphasis on the importance of leadership and strategic decision making. As discussed in the 1994 Rovenstine lecture [2]by the then-editor of this Journal, the anesthesiologist's role is changing, with increased recognition that anesthesiologists are the perioperative medicine specialists.Kempen's correspondence raises several valid concerns and questions regarding the architectural design and evolution of the Anesthesia Preoperative Evaluation Clinic (APEC). As would be expected, the implementation of an APEC is an active process that involves some degree of risk and uncertainty. Innovation and progress requires a program of action to solve problems and to create opportunities. Some questions do not have clear answers or outcomes. However, it is only through a systematic approach that we can begin to evaluate what is functional and that which can be discarded. The process of developing an APEC requires an awareness that not everyone will agree or encourage this endeavor. Norman Vincent Peale put it simply, “If you put off everything till you're sure of it, you'll get nothing done.” The APEC at Stanford University Hospital has become successful in redefining the anesthesiologist's leadership and position as the preoperative medicine specialist.In response to Hannenberg, I agree that delegating certain aspects of the preoperative patient evaluation to the registered nurse practitioner (RNP) may infringe on an area of practice previously relegated only to the expertise of the anesthesiologist. A decade ago, when patients were admitted to the hospital a day before elective surgeries, the assigned anesthesiologist would preoperatively evaluate their patients and establish a personal rapport in a relaxed manner.The dramatic shift to outpatients and same-day admissions has required a change in our practice, to accommodate large volumes of patients (currently 45–50 patients per day at Stanford) and facilitate the anesthesiologists' focus on intraoperative care. Ideally, I would prefer that several anesthesiologists attend the APEC full time, but, current resource allocation does not allow this diversion from operating room to APEC. The RNPs at Stanford are not nurse anesthetists, and their specific clinical duties are under the direct, on-site supervision of the attending anesthesiologist in the APEC. The RNPs evaluate patients for unstable medical conditions and present concerns to the anesthesia medical director. The assigned anesthesia team, on the day of surgery, evaluates and reconfirms their patient's status in the anesthesia holding area before entering the operating room. This establishes a personal rapport with the anesthesiologist who will be directly responsible for the patient's management.Lee and Hillman report a preanesthesia clinic service in Australia with comparable and contrasting development from Stanford's APEC. The conceptual goals appear similar: to provide efficient quality services, increase productivity, and decrease cost. I agree that further studies are needed to define the APEC's role in patient-care outcomes.Silverman discusses the expanding role of the anesthesiologist in today's practice and the increased visibility the APEC can provide. I concur with Silverman that, to expand our specialty into the future, anesthesiology must evolve beyond the traditional operating room/procedure role.Recently at Stanford, the Department of Medicine proposed structuring a preoperative screening clinic staffed by an internist, pulmonologist, and cardiologist for evaluation of presurgical patients. The surgical leadership responded in a concise and congruent manner. They indicated that the anesthesiologists at Stanford are the primary preoperative and operating room medicine experts and that their patients would continue to attend the APEC for presurgical assessment.Positive changes can occur and certain advantages can accrue to the anesthesiologist and department of anesthesia when an APEC is established.Stephen P. Fischer, M.D., Assistant Professor of Anesthesia, Stanford University School of Medicine, Medical Director, Anesthesia, Preoperative Evaluation Clinic, Stanford University Hospital, Stanford, California 94305–5115.(Accepted for publication October 10, 1996.)

Anesthesia Preoperative Evaluation Clinic

Anesthesia Preoperative Evaluation Clinic

Development and Effectiveness of an Anesthesia Preoperative Evaluation Clinic in a Teaching Hospital

Development and Effectiveness of an Anesthesia Preoperative Evaluation Clinic in a Teaching Hospital