Article

Value of Preoperative Clinic Visits in Identifying Issues with Potential Impact on Operating Room Efficiency

Harvard University, Cambridge, Massachusetts, United States
Anesthesiology (Impact Factor: 5.88). 01/2007; 105(6):1254-9; discussion 6A. DOI: 10.1097/00000542-200612000-00026
Source: PubMed

ABSTRACT

Preoperative clinics have been shown to decrease operating room delays and cancellations. One mechanism for this positive economic impact is that medical issues are appropriately identified and necessary information is obtained, so that knowledge of the patients' status is complete before the day of surgery. In this study, the authors describe the identification and management of medical issues in the preoperative clinic.
All patients coming to the Preoperative Clinic during a 3-month period from November 1, 2003, through January 31, 2004, at the Brigham and Women's Hospital, Boston, Massachusetts, were studied. Data were collected as to the type of issue, information needed to resolve the issue, time to retrieve the information, cancellation and delay rates, and the effect on management.
A total of 5,083 patients were seen in the preoperative clinic over the three-month period. A total of 647 patients had a total of 680 medical issues requiring further information or management. Of these issues, 565 were thought to require further information regarding known medical problems, and 115 were new medical problems first identified in the clinic. Most of the new problems required that a new test or consultation be done, whereas most of the old problems required retrieval of information existing from outside medical centers. New problems had a far greater probability of delay (10.7%) or cancellation (6.8%) than old problems (0.6% and 1.8%, respectively).
The preoperative evaluation can identify and resolve a number of medical issues that can impact efficient operating room resource use.

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Available from: Lawrence C Tsen, Nov 07, 2015
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    • "In a study of the effectiveness of a preoperative clinic in the United States, only 17% of issues identified in the testing process were issues previously unknown to the patient. However, if these new issues had not been caught, the resulting day-of-surgery delays would have cost the hospital almost $1,000,000, or $1,500 per delay (Correll et al., 2006). Other studies found similar results (Fischer, 1996). "
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    • "Of the 115 potentially relevant studies identified and screened for retrieval from reading the abstract, 24 were retrieved for more detailed evaluation. After excluding two studies[17,18]that did not fit the selection criteria described above, 22 studies published between 1994 and 2010 in over 400,000 patients were included in the review (Table 2). The studies were conducted in North America (14), Australia (4), Europe (3) and Middle East (1). "
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    • "Das präoperative anästhesiologische Gespräch ist oft anspruchsvoll. Durchschnittlich 20 Minuten wenden Anästhesisten heute dafür auf[23].[25]. Auch was die Zufriedenheit der Patienten betrifft, schneiden solche, personell nicht-kontinuierlichen Systeme der anästhesiologischen Betreuung nicht schlechter ab als der traditionelle Besuch am Vorabend der Operation[23]. "

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