A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment.

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m2, who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.

Production pressures among anaesthesiologists in Singapore.

INTRODUCTION: Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore. METHODS: A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure. RESULTS: Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively. CONCLUSION: Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.