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Grüßer L, Bayram B, Ziemann S, Wallqvist J, Wienhold J, Rossaint R, Derwall M, Follmann A. Teleconsultation for Preoperative Anesthesia Evaluation: Identifying Environmental Potentials by Life Cycle Assessment. Telemed J E Health 2024; 30:e2050-e2058. [PMID: 38656124 DOI: 10.1089/tmj.2023.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Introduction: Teleconsultations for preoperative evaluation in anesthesiology proved to be feasible during the COVID-19 pandemic. However, widespread implementation of teleconsultations has not yet occurred. Besides time savings and economic benefits, teleconsultations in anesthesia may have the potential to reduce CO2 emissions. Methods: We conducted a life cycle assessment based on prospective surveys to assess the potential environmental benefits of preoperative anesthesia teleconsultations in comparison to the status-quo in-person consultations. Within 1 month, all patients presenting at the preoperative anesthesia clinic at RWTH Aachen University Hospital were asked about the distance traveled and mode of transportation to the hospital. The main outcome measure was the potential environmental benefit resulting from the implementation of teleconsultations. Results: In total, 821 out of 981 patients presenting at the anesthesia clinic participated in the survey. Most patients visited on an outpatient basis (62.9%) and traveled by car (81.7%). The median travel distance was 25 km [interquartile range 12-40]. If patients who came to the hospital solely for the anesthesia appointment had scheduled virtual appointments, the emissions of 3.03-ton CO2 equivalents (CO2-eq) could be avoided in the first month after implementation. The environmental impact associated with the production of teleconsultation equipment is outweighed by the reduction in patient travel. If all outpatient appointments were performed virtually, these savings would triple. Within 10 years, more than 1,300 tons CO2-eq could be avoided. Conclusion: Teleconsultations can mitigate the environmental impact of in-person anesthesia consultations. Further research is essential to leverage teleconsultations for preoperative evaluation also across other medical specialties.
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Affiliation(s)
- Linda Grüßer
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Berfin Bayram
- Department Anthropogenic Material Cycles, RWTH Aachen University, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Wienhold
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Andreas Follmann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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2
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Le DQ, Burton BN, Tejeda CJ, Jalilian L, Kamdar N. Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis. Cureus 2024; 16:e60805. [PMID: 38910741 PMCID: PMC11189693 DOI: 10.7759/cureus.60805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion. Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%). CONCLUSIONS This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.
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Affiliation(s)
- Danny Q Le
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Brittany N Burton
- Anesthesiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Christian J Tejeda
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Laleh Jalilian
- Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Nirav Kamdar
- Quality Improvement and Clinical Operations, Huntington Hospital, Pasadena, USA
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Follmann A, Wienhold J, Arnolds A, Derwall M, Rossaint R, Czaplik M. [Telemedical anesthesia consent - Are the patients ready for it? : A comparative requirement analysis before and during the pandemic]. DIE ANAESTHESIOLOGIE 2024; 73:156-164. [PMID: 38366156 PMCID: PMC10920479 DOI: 10.1007/s00101-024-01387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Comprehensive anesthesia preparation by means of the anamnesis and physical examination is considered an essential part of the quality criteria for anesthesia. Especially due to the shortage of specialists, there are usually long waiting times in anesthesia outpatient departments and patients must frequently return in cases of missing or pending findings. Telemedicine already offers alternatives in the context of video communication. These alternatives are now particularly prominent due to the currently existing COVID-19 pandemic and the resulting recommendations for digitalization. OBJECTIVES This comparative cross-sectional study was carried out to show via a patient survey which patient groups are suitable for a telemedical anesthesia preparation and whether the patients are already technically sufficiently equipped. MATERIAL AND METHODS For this purpose, a total of 2080 patients (1030 before and 1050 during the pandemic) were interviewed using a questionnaire. For matched paired analyses, 630 pairs were formed according to their age and gender. RESULTS Before and after the pandemic, there was an increase in the percentage of patients already using video communication in their daily lives (30.4% vs. 41.8%). Before the pandemic, 31.7% of patients indicated that they considered this concept of communication to be a practical and appropriate method for an educational conversation and after the pandemic this number increased to 46.6%. For the majority of patients personal contact with a local anesthesiologist was important (80.7% before vs. 67.4% during the pandemic). The number of patients who had the necessary technical equipment for video communication also increased as a result of the COVID-19 pandemic (50.4% vs. 58.2%). DISCUSSION Almost half of the patients already seem to be open to a telemedical preoperative evaluation. As digitalization progresses, older generations are more likely to recognize the benefits and be able to own and use the necessary technology in the near future. User acceptance should be the central goal of concept development. This must be followed by a randomized controlled study to evaluate the potentials but also the problems in the perioperative process.
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Affiliation(s)
- A Follmann
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - J Wienhold
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - A Arnolds
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Derwall
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, St. Johannes Hospital Dortmund, Dortmund, Deutschland
| | - R Rossaint
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Docs in Clouds TeleCare GmbH, Aachen, Deutschland
| | - M Czaplik
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Docs in Clouds TeleCare GmbH, Aachen, Deutschland
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Morau E, Chevallier T, Serrand C, Perin M, Gricourt Y, Cuvillon P. Teleconsultation compared with face-to-face consultation in the context of pre-anesthesia evaluation: TELANESTH, a randomized controlled single-blind non-inferiority study. J Clin Anesth 2024; 92:111318. [PMID: 37944402 DOI: 10.1016/j.jclinane.2023.111318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
STUDY OBJECTIVE During the COVID crisis, pre-anesthesia teleconsultations were widely used leading to savings in time and money. However, the non-inferiority of this system has not yet been evaluated. DESIGN Prospective, randomized, controlled, single-blind non-inferiority study. SETTING University hospital. PATIENTS Patients scheduled for surgery requiring a single pre-anesthesia consultation (PAC). INTERVENTION Pre-anesthesia teleconsultation (PATC) from patient's home. MEASUREMENTS Primary outcome: concordance between the pre-anesthesia visit (PAV), performed on the day of surgery, and PAC or PATC on: Secondary outcomes: cancellation rate, immediate perioperative complications, patient satisfaction, organization, and economic and ecological costs. MAIN RESULTS Out of 172 patients included, 149 were analyzed. PATC was no less effective than PAC in terms of the primary outcome or each of its components: the difference between groups was: - 0.044[90% CI: -0.135; 0.047] (p = 0.0002). There was no difference in cancellation rates (PAC 1.99% vs. PATC 1.27%, p = 0.6) or in immediate perioperative complications (none). Satisfaction was 9.48 (±1.45) in the PAC group and 8.96 (±1.68) in the PATC group (p = 0.0006). In the PATC group, the mean savings per patient were 30 km (± 29), 36 min (± 27), and 18 (± 18) euros, respectively. CONCLUSIONS According to our criteria, PATC was not inferior to PAC for preoperative patient evaluation and may be an interesting economical, ecological alternative.
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Affiliation(s)
- Estelle Morau
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France.
| | - Thierry Chevallier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Mikael Perin
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Yann Gricourt
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
| | - Philippe Cuvillon
- Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France
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5
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Guerrier G, Ohayon J, Rothschild PR, Baillard C. Is it safe to use telephone for anaesthesia consultation in high-risk patients before non-invasive surgery? A pilot study in ophthalmology. J Telemed Telecare 2024:1357633X231222661. [PMID: 38280210 DOI: 10.1177/1357633x231222661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Although telemedicine with video support for preoperative evaluation has been found effective, there is limited research on anaesthesia consultation by phone without video support, particularly among high-risk patients. To evaluate the effectiveness, safety and potential benefits of performing pre-anaesthesia evaluation by phone before eye surgery in patients having non-invasive surgery, we performed an observational study in a French teaching hospital. METHOD All elective patients having elective ophthalmic surgery were included to have a consultation by phone instead of an in-person consultation, regardless of the type of anaesthesia or ASA score. The incidence of day-of-surgery cancellations, patient satisfaction and time/distance saved through phone consultations were assessed. RESULTS From February to October 2022, data of 3480 patients were analyzed, including 370 (11%) high-risk patients (ASA 3-4). Anaesthesia-related day-of-surgery cancellation rate was 0.5% (n = 20) due to non-compliance with pre-operative instructions. No cancellation was due to inadequate pre-operative evaluation. No difference in cancellation rate was observed between low-risk patients and high-risk patients. Telephone consultations saved patients a mean of 126 min and 86 km. A younger age, an active status and living far from the hospital were associated with phone consultation preference. CONCLUSION Phone anaesthesia consultation seems to be effective and safe before ophthalmic surgery, regardless of patient's perioperative risk. In addition, phone consultation provides significant time and distance savings. Our results must be confirmed through a multicentric randomised study comparing phone and traditional consultation in ophthalmology as well as in other non-invasive surgical procedures in a high-risk patients population.
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Affiliation(s)
- Gilles Guerrier
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
| | - Johanna Ohayon
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Raphaël Rothschild
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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Wienhold J, Kemper I, Czaplik M, Follmann A, Rossaint R, Derwall M. [Teleconsultation for preoperative evaluation and informed consent-Are we ready for a paradigm shift?]. DIE ANAESTHESIOLOGIE 2023; 72:697-702. [PMID: 37563314 DOI: 10.1007/s00101-023-01319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
In Germany, approximately 17 million anaesthesiological procedures and, consequently, roughly the same number of preoperative consultations are conducted each year. So far, these have predominantly taken place in person. However, recent developments in technology, medical-legal aspects, and politics, combined with the catalyzing effect of the pandemic situation, have led to a significant boost in telemedicine. In the field of anaesthesia, there are new approaches to implementing telemedicine in the pre- and postoperative setting. This article focuses on the preoperative setting and presents general requirements for a teleconsultation as preoperative evaluation, the current state of technology, and medical-legal aspects.
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Affiliation(s)
- Jan Wienhold
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Ilka Kemper
- Geschäftsbereich Recht, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Michael Czaplik
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Andreas Follmann
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Rolf Rossaint
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Matthias Derwall
- St. Johannes Hospital Dortmund, Johannesstraße 9-17, 44137, Dortmund, Deutschland
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Davenport A, Brunn E, Creswell M, Sholklapper T, Ringel N, Gutman R. Exploring Patient Perspectives Surrounding Telemedicine Versus In-Person Preoperative Visits. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:323-329. [PMID: 36701389 DOI: 10.1097/spv.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
IMPORTANCE Telemedicine was increasingly used to provide patients with an alternative to in-office visits during the COVID-19 pandemic. While previous studies have described the role of telemedicine for preoperative visits for other surgical specialties, the role of this modality in preoperative visits for gynecologic surgery has not been thoroughly explored. OBJECTIVES The aims of the study are to explore and compare patient experience, decision making, and satisfaction among women undergoing telemedicine or in-person preoperative visits. STUDY DESIGN This was a qualitative study of women who underwent a preoperative appointment with a urogynecologic surgeon or minimally invasive gynecologic surgeon at a single academic institution from April to May of 2021. Data were collected using semistructured phone interviews, which focused on visit content, visit type decision making, surgical preparedness/confidence, and past surgical experiences. Interviews were thematically analyzed until theoretical saturation was achieved in accordance with grounded theory. RESULTS Theoretical saturation occurred with 20 interviews. Participants were evenly divided between in-person and telemedicine visits. Major themes included visit content, experience/quality, surgeon perception, and surgical preparedness. Advantages of telemedicine visits were convenience and safety. Advantages of in-person visits were social factors, perceived medical or surgical severity, and preoperative physical examination. Disadvantages for telemedicine visits included technology concerns and difficulty accessing preoperative materials. The disadvantage of an in-person visit was the inability to have family present because of COVID hospital policy restrictions. Participants in both groups felt prepared for surgery and reported high satisfaction with their care. CONCLUSIONS Decision making for selecting an in-person or telemedicine visit is complex and involves balancing multiple advantages and disadvantages. Participant experience was similar for both visit types with high satisfaction.
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Affiliation(s)
| | | | | | | | - Nancy Ringel
- Division of Urogynecology and Reconstructive Pelvic Surgery, Yale University School of Medicine, New Haven, CT
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8
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Chai JX, Lim WY, Au Yong APS, Ong SGK. A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment. Cureus 2023; 15:e40449. [PMID: 37456373 PMCID: PMC10349366 DOI: 10.7759/cureus.40449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
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.
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Affiliation(s)
- Jia Xin Chai
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Wan Yen Lim
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Angie Phui Sze Au Yong
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Sharon Gek Kim Ong
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
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Flexman AM, Ke J, Hallet J. Innovating for Value-Based Surgical Care in Canada: A Post-Pandemic Necessity. Healthc Policy 2023; 18:43-56. [PMID: 37486812 PMCID: PMC10370401 DOI: 10.12927/hcpol.2023.27094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Providing high-quality, efficient and cost-effective surgical care to Canadians has become increasingly challenging since the pandemic, resulting in long waitlists due to limited staff and resources. The pandemic has facilitated some areas of innovation in surgical care, notably in virtual care and expedited discharge, although many challenges remain. Key policy recommendations for reform include investing in infrastructure to collect and report on value-based metrics beyond volume, devising strategies to improve health equity, enhancing out-of-hospital support for surgical patients by using remote monitoring and digital technology, increasing patient segmentation into low- and high-complexity pathways, centralizing surgical triage and initiating careful financial incentivization of integrated groups of clinicians.
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Affiliation(s)
- Alana M Flexman
- Clinical Associate Professor, Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Anesthesiologist, Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Affiliated Scientist, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC
| | - Janny Ke
- Clinical Assistant Professor, Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Anesthesiologist, Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC
| | - Julie Hallet
- Associate Professor, Department of Surgery, Division of General Surgery, University of Toronto, Surgical Oncologist, Sunnybrook Health Sciences Centre, Adjunct Scientist, ICES, Toronto, ON
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10
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Greco M, Angelucci A, Avidano G, Marelli G, Canali S, Aceto R, Lubian M, Oliva P, Piccioni F, Aliverti A, Cecconi M. Wearable Health Technology for Preoperative Risk Assessment in Elderly Patients: The WELCOME Study. Diagnostics (Basel) 2023; 13:diagnostics13040630. [PMID: 36832119 PMCID: PMC9955976 DOI: 10.3390/diagnostics13040630] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Preoperative identification of high-risk groups has been extensively studied to improve patients' outcomes. Wearable devices, which can track heart rate and physical activity data, are starting to be evaluated for patients' management. We hypothesized that commercial wearable devices (WD) may provide data associated with preoperative evaluation scales and tests, to identify patients with poor functional capacity at increased risk for complications. We conducted a prospective observational study including seventy-year-old patients undergoing two-hour surgeries under general anesthesia. Patients were asked to wear a WD for 7 days before surgery. WD data were compared to preoperatory clinical evaluation scales and with a 6-min walking test (6MWT). We enrolled 31 patients, with a mean age of 76.1 (SD ± 4.9) years. There were 11 (35%) ASA 3-4 patients. 6MWT results averaged 328.9 (SD ± 99.5) m. Daily steps and 𝑉𝑂2𝑚𝑎𝑥 as recorded using WD and were associated with 6MWT performance (R = 0.56, p = 0.001 and r = 0.58, p = 0.006, respectively) and clinical evaluation scales. This is the first study to evaluate WD as preoperative evaluation tools; we found a strong association between 6MWT, preoperative scales, and WD data. Low-cost wearable devices are a promising tool for the evaluation of cardiopulmonary fitness. Further research is needed to validate WD in this setting.
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Affiliation(s)
- Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Correspondence:
| | - Alessandra Angelucci
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Gaia Avidano
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| | - Giovanni Marelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Stefano Canali
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
- META—Social Sciences and Humanities for Science and Technology, Politecnico di Milano, 20133 Milan, Italy
| | - Romina Aceto
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marta Lubian
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Paolo Oliva
- Clinical Engineering, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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11
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Oui à la téléconsultation préanesthésique ! ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Patient satisfaction with divided anesthesia care. DIE ANAESTHESIOLOGIE 2023; 72:97-105. [PMID: 36036254 PMCID: PMC9892151 DOI: 10.1007/s00101-022-01192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Up to now, no prospective cohort study using a validated questionnaire has assessed patients' expectation and perception of divided anesthesia care and its influence on patient satisfaction. OBJECTIVE We assessed patient satisfaction with divided anesthesia care in a district general hospital in Switzerland. We hypothesized that patient expectations, combined with their perceptions of the (un)importance of continuous anesthesia care would influence patient satisfaction. MATERIAL AND METHODS A total of 484 eligible in-patients receiving anesthesia from October 2019 to February 2020 were included and received preoperative information about divided care via a brochure and face-to-face. The primary outcome was the assessment of patient satisfaction with divided anesthesia care using a validated questionnaire. In group 1 continuity of care was considered important but not performed. In group 2 continuity was ensured. In group 3 continuity was regarded as not important and was not performed. In group 4 patients could not remember or did not answer. A psychometrically developed validated questionnaire was sent to patients at home after discharge. RESULTS A total of 484 completed questionnaires (response rate 81%) were analyzed. In group 1 (n = 110) the mean total dissatisfaction score was 25% (95% confidence interval [CI] 21.8-28.1), in group 2 (n = 61) 6.8% (95% CI 4.8-8.7), in group 3 (n = 223) 12.1% (95% CI 10.7-13.4), and in group 4 (n = 90) 15% (95% CI 11-18); ANOVA: p < 0.001, η = 0.43. Of the patients 286 (59%) considered continuity of care by the same anesthetist relatively unimportant (34%) or not important at all (25%). The other 40% considered it important (22%) or very important (18%). CONCLUSION Despite receiving comprehensive preoperative information about divided anesthesia care, 40% of patients still considered continuity of care by the same anesthetist important. We recommend further research evaluating whether and how patient expectations can be modified towards the common practice of divided care and patient satisfaction can be increased.
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation. RECENT FINDINGS Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams. SUMMARY The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.
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