Increasing teleconsultation utilisation for pre-operative anaesthesia evaluation in the COVID-19 pandemic era: a qualityimprovement project

ABSTRACT

The COVID-19 pandemic has accelerated the growth of telemedicine. Advantages include patient convenience, reduced waiting time, minimising hospital commute and the risk of virus transmission and healthcare cost-savings [1]. Compared with other specialties, anaesthesiology is less engaged with telemedicine- based clinical work and challenges in implementation exist [2]. To align with the Ministry of Health, Singapore COVID-19-safe management measures, pre-anaesthetic assessment via video consultation (VC) workflow was implemented in Sengkang General Hospital, Singapore, in December 2020;however, the referral rate amongst our surgical colleagues remained low. Therefore the aim was to increase the number of VCs by 50% within 12 months (from June 2021) and evaluate patients' experiences. Methods Eligibility criteria included low-risk surgeries (duration < 4 h) with minimal expected blood loss, patients aged 21-65 years, ASA status 1 or 2, body mass index < 35 and the patient's ability to use the Zoom video-conferencing application. Post-consultation, patients were invited to complete an electronic patient satisfaction survey. The main reasons for the low VC referral rate were identified based on ground engagement and feedback. Two plan-do-study-act (PDSA) cycles were conducted to address these issues. PDSA cycle 1 (June 2021) to increase awareness amongst surgeons, surgical champions were engaged to promote VC within their departments;however, the VC referral rate remained low. Therefore, a second PDSA cycle was undertaken. PDSA cycle 2 (October 2021) to increase patient and staff awareness by placing posters publicising VC and enlisting the help of Patient Service Associates (PSAs) to screen for patient eligibility. This led to a significant increase in VC referrals. The current workflow will be evaluated for sustainability. Results Pre-intervention, the average number of monthly VCs was 3, and remained unchanged during PDSA cycle 1. This was increased to 14 during PDSA cycle 2. Discussion VC referrals have increased after the modified workflow, achieving high patient satisfaction and no surgical cancellations. Future work includes developing an automated VC workflow for low-risk surgeries. (Figure Presented).