Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil S.; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

doi:10.4137/hsi.s40540

Cited by 15 publications

(23 citation statements)

References 36 publications

(57 reference statements)

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“…Diese ist als Meilenstein auf dem Weg zu einer pragmatischen und proaktiven Risikostratifizierung unserer Patienten zu sehen. Präoperative Evaluation beinhaltet eine zielgerichtete, interdisziplinäre und effiziente Risikoanalyse im Hinblick auf die operative Prozedur [14][15][16][17][18]. Dabei ist auch die postoperative Behandlung auf der Normalstation, an einem Monitorplatz, in einer IMC bzw.…”

Section: Präoperative Evaluation In Der Anästhesieambulanzunclassified

“…Als optimale Struktur bietet sich in vielen Kliniken eine Anästhesieambulanz an, die nach konsentierten und bestmöglich evidenzbasierten Kriterien arbeitet [14,15]. Hier liegt das Fundament für die Analyse und Verbesserung des Patientenzustands, die Erhöhung der Patientensicherheit und nicht zuletzt die Steigerung der Patientenzufriedenheitdenn auch die Erwartungen und Sorgen des Patienten sollen in der präoperativen Evaluation zur Sprache kommen [20].…”

Section: Vorgehenunclassified

“…Unnötige Untersuchungen verschlingen zudem zeitliche und finanzielle Ressourcen. Dagegen können klare, interdisziplinär diskutierte Vereinbarungen den Ertrag der Konsultationen immens erhöhen[14,15].Zusatzuntersuchungen werden auf Outcome-relevante Fälle beschränkt. Sie werden nur durchgeführt, ▪ wenn der Patientenzustandz.…”

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Anästhesie und Outcome: Einfluss der perioperativen Prozesse

Zieger¹,

Häberle²

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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In recent years, the role of the anesthesiologist has turned tremendously from the "anaesthesia doctor" into a perioperative physician and risk specialist. Patients are older, multimorbid, and are called up for more and more extensive surgery and interventions. Socioeconomic aspects have grown in importance. The anesthesiologist, paving the way for a good outcome, is involved in nearly all perioperative processes: preoperative evaluation, definition and optimization of preoperative and intraoperative conditions, management of modern intraoperative anesthesia as well as postoperative medically indicated, effective and efficient treatment of partially highly complex patients. The individual perioperative process steps in this way are examined in accordance with established guidelines and the increase in current requirements. Finally, a special emphasis is placed on the perception that the perioperative process has not been completed with the end of surgery - postoperative outcome is not least adversely affected by postoperative complications on the normal ward. The risk of death after complications, "failure to rescue", should be identified early and treated promptly.

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Section: Präoperative Evaluation In Der Anästhesieambulanzunclassified

Section: Vorgehenunclassified

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Anästhesie und Outcome: Einfluss der perioperativen Prozesse

Zieger¹,

Häberle²

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…The purpose of developing a preassessment clinic is to select appropriate patients, reduce hospital admission lengths through patient optimisation, suitably schedule theatre times and therefore lead to cost savings. 12 This clinic structure is predominantly used for surgical procedures with preassessment clinics an integral step in improving service productivity and resulting in cost savings prior to any cardiac surgery. 13 Despite the range of invasive cardiac procedures, there is a relative lack of cardiology preassessment clinics.…”

Section: Importance Of Preassessment Clinicsmentioning

confidence: 99%

Economic evaluation of a dedicated cardiac resynchronisation therapy preassessment clinic

et al. 2020

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IntroductionPatient evaluation before cardiac resynchronisation therapy (CRT) remains heterogeneous across centres and it is suspected a proportion of patients with unfavourable characteristics proceed to implantation. We developed a unique CRT preassessment clinic (CRT PAC) to act as a final review for patients already considered for CRT. We hypothesised that this clinic would identify some patients unsuitable for CRT through updated investigations and review. The purpose of this analysis was to determine whether the CRT PAC led to savings for the National Health Service (NHS).MethodsA decision tree model was made to evaluate two clinical pathways; (1) standard of care where all patients initially seen in an outpatient cardiology clinic proceeded directly to CRT and (2) management of patients in CRT PAC.Results244 patients were reviewed in the CRT PAC; 184 patients were eligible to proceed directly for implantation and 48 patients did not meet consensus guidelines for CRT so were not implanted. Following CRT, 82.4% of patients had improvement in their clinical composite score and 57.7% had reduction in left ventricular end-systolic volume ≥15%. Using the decision tree model, by reviewing patients in the CRT PAC, the total savings for the NHS was £966 880. Taking into consideration the additional cost of the clinic and by applying this model structure throughout the NHS, the potential savings could be as much as £39 million.ConclusionsCRT PAC appropriately selects patients and leads to substantial savings for the NHS. Adopting this clinic across the NHS has the potential to save £39 million.

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“…penelitian yang menyatakan pentingnya pelaksanaan asesmen praanestesi terutama untuk menurunkan angka penundaan ataupun kegagalan pelaksanaan operasi serta berdampak pada lama perawatan pasien pascaoperasi. Hal tersebut pada akhirnya juga akan berdampak pada efisiensi biaya perawatan pasien (Bader, Sweitzer, & Kumar, 2009;Conny & Wan-Yim, 2016;Lozada, Nguyen, Abouleish, Prough, & Przkora, 2016;Tariq, Ahmed, Kulkarni, Hanif, Toolsie, Abbas, & Chilimuri, 2016). Mengingat hal tersebut, pelayanan rawat jalan untuk anestesi atau yang lebih dikenal dengan Anesthesia Preoperative Evaluation Clinic (APEC) atau ada juga yang menyebut Preoperative Assessment Clinic (POAC) telah banyak dikembangkan terutama di luar negeri (Bader et al, 2009;Conny & Wan-Yim, 2016;Fischer, 1996;Reuter, Jurack, Engelmann, Busch, & Schnoor, 2014;Sebach, Rockelli, Reddish, Jarosinski, & Dolan Jr, 2015;Tariq et al, 2016;Yakubu, 2018).…”

Section: Banyakunclassified

Asesmen Pra-Anestesi: Bukan Sekedar Kepatuhan

Agustina

Wardhani

Astari

2020

JHA

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Latar Belakang: Asesmen praanestesi adalah prosedur penting yang bertujuan untuk memastikan keamanan tindakan bedah yang akan dilakukan. Prosedur ini sebenarnya adalah tanggung jawab dokter anestesiologi. Namun, dalam prosesnya melibatkan dokter, perawat serta pasien dan keluarganya. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran pelaksanaan asesmen praanestesi serta menggali praktik pendelegasian tugas (task shifting) dalam pelaksanaan asesmen praanestesi di ruangan rawat inap. Metode: Penelitian ini dilakukan di sebuah rumah sakit (RS) tipe C (140 tempat tidur) di kota Malang Jawa Timur. Peneliti melakukan observasi selama 11 hari terhadap pelaksanaan asesmen praanestesi pada kasus operasi elektif. Untuk melengkapi data, dilakukan juga pengamatan terhadap dokumen rekam medis pasien yang sama. Untuk menilai praktik pendelegasian tugas dari dokter ke perawat, peneliti menggunakan kuesioner yang berisi 28 aspek aktivitas asesmen praanestesi. Kuesioner ini didistribusikan kepada 80 orang responden yang terdiri dari perawat dan dokter spesialis yang terlibat dalam operasi elektif. Kuesioner ini menilai persepsi responden mengenai harapan dan kenyataan tentang siapa yang seharusnya melaksanakan aktivitas tersebut. Data dianalisis secara deskriptif untuk menggambarkan pola pelaksanaan pendelegasian tugas dan asesmen praanestesi. Hasil: Asesmen praanestesi hanya dilakukan pada 19,5% dari total 43 kasus operasi elektif, namun tidak satupun yang menuliskan hasil asesmen pada dokumen yang semestinya. Dokumen rekam medis tentang asesmen praanestesi akan dilengkapi saat setelah pelaksanaan operasi (di kamar operasi). Sebagian besar responden beranggapan bahwa asesmen praanestesi dilaksanakan secara kolaborasi antara dokter dan perawat. Namun, dalam praktiknya, kebanyakan aktivitas dalam asesmen praanestesi dilakukan oleh perawat. Pendelegasian tertinggi dari dokter ke perawat terjadi pada aspek meminta tanda tangan persetujuan tindakan medis (informed consent) serta aspek menjelaskan tentang puasa kepada pasien dan keluarganya. Kesimpulan: Asesmen praanestesi belum terdokumentasi dengan lengkap dan tepat sebelum pelaksanaan operasi, serta terjadi pendelegasian tugas ke perawat terutama pada proses persetujuan tindakan medis.

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Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

Cited by 15 publications

References 36 publications

Anästhesie und Outcome: Einfluss der perioperativen Prozesse

Anästhesie und Outcome: Einfluss der perioperativen Prozesse

Economic evaluation of a dedicated cardiac resynchronisation therapy preassessment clinic

Asesmen Pra-Anestesi: Bukan Sekedar Kepatuhan

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