Evaluación preoperatoria «on line» frente a evaluación presencial: optimización de recursos / Online versus non-standard face to face preoperative assessment: Cost effectiveness

Objetivos. Evaluar la implementación de un nuevo modelo de consulta preoperatoria mediante la reducción de visitas presenciales y pruebas complementarias en distintos procedimientos. Métodos. Desarrollamos un nuevo modelo de evaluación preoperatoria en el que el anestesiólogo evalúa on line, sin presencia del paciente, la historia clínica y las pruebas complementarias procedentes de la atención primaria y hospitalaria. A partir de esa información, confirmada mediante una llamada telefónica, el especialista decidía la necesidad de visita presencial y seleccionaba las pruebas complementarias en base a la complejidad del procedimiento quirúrgico y riesgo anestésico del paciente. En determinados procedimientos la enfermera previamente «entrenada» recogía on line dicha información y en caso de duda consultaba al anestesiólogo. Comparamos una cohorte de pacientes prequirúrgicos antes de la implantación de este nuevo modelo preoperatorio (año 2008) y después (año 2010). Contabilizamos en ambos períodos, el número de visitas presenciales y pruebas complementarias realizadas. Se comparó la tasa de anulaciones quirúrgicas para ambos períodos. Resultados. Se valoraron 5.112 procedimientos de cirugía programada en el año 2008 y 6.867 procedimientos en el 2010. La complejidad quirúrgica fue similar en ambos períodos. En el 2010 las visitas presenciales descendieron a un 21%, el número de analíticas a un 15%, el de electrocardiogramas a un 6% y el número de radiografías de tórax a un 1%. La tasa de anulaciones quirúrgicas descendió del 2,3 al 1,75%. Conclusiones. Este método preoperatorio optimiza los recursos al reducir las visitas presenciales y las pruebas complementarias sin aumentar la tasa de anulaciones quirúrgicas(AU)

Objectives. We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. Methods. We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. Results. 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn’t differ between 2008 (2,3%) and 2010 (1.75%). Conclusions. This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate(AU)

[Online versus non-standard face to face preoperative assessment: cost effectiveness]. / Evaluación preoperatoria «on line¼ frente a evaluación presencial: optimización de recursos.

OBJECTIVES: We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. METHODS: We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. RESULTS: 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn't differ between 2008 (2,3%) and 2010 (1.75%). CONCLUSIONS: This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate.