Integrated assessment and consultation for the preoperative patient

Comprehensive Preoperative Assessment and Global Optimization

To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.

Using Key Performance Indicators to Reduce Perceived Perioperative Complexity and Improve Patient Workflow

This study examines the development and use of balanced scorecard metrics as key performance indicators within each stage of the perioperative process to enable business process management across the entire process to gauge performance and target improvement opportunities. The identification of existing limitations, potential capabilities, and the subsequent contextual understanding are contributing factors toward perioperative improvement. This paper identifies how dynamic technological activities of analysis, evaluation, and synthesis applied to internal and external organizational data can highlight complex relationships within integrated hospital processes to address root causes rather than symptoms and ultimately yield improved capabilities. This case study investigates how integrated information systems can identify, qualify, and quantify perioperative performance indicators to measure improvement based on a 157-month longitudinal study of a large, 1,157 registered-bed teaching hospital. The theoretical and practical implications and/or limitations of this study's results are also discussed with respect to practitioners and researchers alike.

A national survey on current practice of preanaesthetic assessment in elective surgery patients in Spain

OBJECTIVE

To analyse the preanaesthetic assessment prior to elective surgery in hospitals of the Spanish National Health Care System.

METHODS

A prospective cross-sectional descriptive observational survey was performed. Primary variables were patient characteristics, type of preanaesthetic evaluation and the evaluator, as well as type of support the evaluator received during patient assessment. Secondary variables included the number of operating rooms available for elective surgery, as well as preanaesthesia clinic facilities. Data were analysed by univariate and bivariate descriptive analysis.

RESULTS

A total of 214 hospitals of the Spanish Health Care System were invited to participate, and 203 centres responded, with all of them having a preanaesthesia assessment clinic. In 183 of them (90%), elective surgerypatients were interviewed prior to their surgical intervention, and in 202 hospitals (99.5%) a anaesthesiologist physician performed the interview. In 128 hospitals (63%), anaesthesiologists were helped during preoperative assessment by nurses alone (49%) or together with auxillary nurses (14%). In 68 of hospitals (33%) they were supported only by auxillary nurses and in 7 hospitals (3%) they obtained no help at all. In 14 centres (7%) anaesthesia nurses assessed patients directly (under supervision of an anaesthesiologist physician). Hospitals with a higher volume of patients performed more preanaesthesia interviews. Hospitals with more running operating rooms received more nurse support in the preanaesthesia assessment clinic.

CONCLUSIONS

Some kind of preanaesthesia assessment clinic exists in all Anaesthesia Departments of public Spanish hospitals, although there are differences in design and organisation.