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Evaluation of electronic screening in the preoperative process.
van den Blink, Aneya; Janssen, Liedewij M J; Hermanides, Jeroen; Loer, Stephan A; Straat, Fidessa K; Jessurun, Estaban N; Schwarte, Lothar A; Schober, Patrick.
  • van den Blink A; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: a.vandenblink@amsterdamumc.nl.
  • Janssen LMJ; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: liedewij.janssen@amsterdamumc.nl.
  • Hermanides J; Amsterdam UMC location University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands. Electronic address: j.hermanides@amsterdamumc.nl.
  • Loer SA; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: s.loer@amsterdamumc.nl.
  • Straat FK; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: f.straat@amsterdamumc.nl.
  • Jessurun EN; Amsterdam UMC location University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands. Electronic address: ejessurun@spaarnegasthuis.nl.
  • Schwarte LA; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: l.schwarte@amsterdamumc.nl.
  • Schober P; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: p.schober@amsterdamumc.nl.
J Clin Anesth ; 82: 110941, 2022 11.
Article in English | MEDLINE | ID: covidwho-2015588
ABSTRACT
STUDY

OBJECTIVE:

Rising patient numbers, with increasing complexity, challenge the sustainability of the current preoperative process. We evaluated whether an electronic screening application can distinguish patients that need a preoperative consultation from low-risk patients that can be first seen on the day of surgery.

DESIGN:

Prospective cohort study.

SETTING:

Preoperative clinic of a tertiary academic hospital. PATIENTS 1395 adult patients scheduled for surgery or procedural sedation.

INTERVENTIONS:

We assessed a novel electronic preoperative screening application which consists of a questionnaire with a maximum of 185 questions regarding the patient's medical history and current state of health. The application provides an extensive health report, including an American Society of Anesthesiologists physical status (ASA-PS) classification and a recommendation for either consultation by an anesthesiologist at the preoperative clinic or approval for screening on the day of surgery. MEASUREMENTS The recommendation of the electronic screening system was compared with the regular preoperative assessment using measures of diagnostic accuracy and agreement. Secondary outcomes included ASA-PS classification, patient satisfaction, and the anesthesiologists' opinion on the completeness and quality of the screening report.

RESULTS:

Sensitivity to detect patients who needed additional consultation was 97.5% (95%CI 91.2-99.7) and the negative likelihood ratio was 0.08 (95%CI 0.02-0.32). 407 (29.2%) patients were approved for surgery by both electronic screening and anesthesiologist. In 909 (65.2%) cases, the electronic screening system recommended further consultation while the anesthesiologist approved the patient (specificity 30.9% (95%CI 28.4-33.5); poor level of agreement (ĸ = 0.04)). Agreement regarding ASA-PS classification scores was weak (ĸ = 0.48). The majority of patients (78.0%) felt positive about electronic screening replacing the regular preoperative assessment.

CONCLUSIONS:

Electronic screening can reliably identify patients who can have their first contact with an anesthesiologist on the day of surgery, potentially allowing a major proportion of patients to safely bypass the preoperative clinic.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Preoperative Care / Anesthesiologists Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: J Clin Anesth Journal subject: Anesthesiology Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Preoperative Care / Anesthesiologists Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: J Clin Anesth Journal subject: Anesthesiology Year: 2022 Document Type: Article