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


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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    ABSTRACT: Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada. We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines. We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.
    Full-text · Article · May 2015 · Advances in Health Care Management
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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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    ABSTRACT: There has been a recent widespread international 'paradigm shift' to new Perioperative Systems for surgical patient care. These new systems are based on a multidisciplinary team providing an integrated process of care from the time a decision is made that a patient should have an operation until the patient has recovered from surgery. The objectives of this review were to outline the rationale for new Perioperative Systems, synthesize the evidence supporting these new systems and consider the current state of Perioperative Systems and its future development. A systematic review of studies that focus on preoperative management practices to improve patient preparation for surgery and anaesthesia, with restriction to study designs with the highest levels of evidence for the synthesis of evidence. Perioperative Systems are regarded as the standard model of care in Australia, New Zealand, North America and increasingly in Europe. The benefits of Perioperative Systems include: increased surgical volume and flow (20-35%), shorter preoperative length of stay (-0.2 to -1.3 days), fewer cancellations of surgery (absolute reduction 1-8%), relative reduction in the number (23-55%) and cost (40-59%) of preoperative investigations and a lower risk of wound infection (relative risk 0.30, 95% CI 0.12-0.78) compared to the traditional system. The mean reduction in the total cost per patient associated with a Perioperative System was 8-18%. Future developments include offering health promotion activities in the weeks before surgery to improve long term patient outcomes after surgery. There is evidence of quality benefits for patients, clinicians and health administrators associated with new Perioperative Systems. Despite this, these systems are yet to be fully developed in many jurisdictions.
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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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