The impact of reduction of testing at a Preoperative Evaluation Clinic for elective cases: Value added without adverse outcomes

Nelson, Sara E.; Li, Gen; Shi, Hanyuan; Terekhov, Maxim A.; Ehrenfeld, Jesse M.; Wanderer, Jonathan P.

doi:10.1016/j.jclinane.2018.12.027

Cited by 18 publications

(26 citation statements)

References 31 publications

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“…Recent evidence suggests, however, that routine lab testing is still performed in a variety of perioperative settings despite contradictory guidelines [28]. In such scenarios, streamlining preoperative workflow can reduce the number of routine lab tests and imaging procedures performed, without a significant increase in case cancellations, length of stay, or readmission [29]. Hence, to guarantee safety, solid knowledge of current guidelines is a prerequisite for focused testing in the ambulatory setting [30].…”

Section: Key Pointsmentioning

confidence: 99%

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Filipovic

Schwenter

Luedi

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewAmbulatory 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 findingsIdentifying 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.SummaryThe 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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Section: Key Pointsmentioning

confidence: 99%

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Filipovic

Schwenter

Luedi

et al. 2022

Current Opinion in Anaesthesiology

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“…10 Previous studies have found no increase in case cancellations, length of stay (LOS), readmission, or same-day testing for patients not undergoing preoperative testing. [10][11][12] Similarly, there is a risk of having a clinically insignificant abnormal test result which could result in delayed care of the patient. 13 As such, eliminating low-value tests can result in cost savings without jeopardizing patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…13 As such, eliminating low-value tests can result in cost savings without jeopardizing patient outcomes. 11,14,15 Organizations such as the American Society of Anesthesiologists (ASA) and European Society of Anesthesiology have recommended adopting a patientcentered approach when determining a need for PLT. 11,12 Endoscopic sinonasal surgery (ESS) is one of the most common outpatient procedures in the United States, with over 250 000 ambulatory surgeries annually.…”

Section: Introductionmentioning

confidence: 99%

“…11,14,15 Organizations such as the American Society of Anesthesiologists (ASA) and European Society of Anesthesiology have recommended adopting a patientcentered approach when determining a need for PLT. 11,12 Endoscopic sinonasal surgery (ESS) is one of the most common outpatient procedures in the United States, with over 250 000 ambulatory surgeries annually. [16][17][18] To the authors' knowledge, no study has examined the value of PLT in ESS.…”

Section: Introductionmentioning

confidence: 99%

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Utility of Preoperative Laboratory Testing for Ambulatory Endoscopic Sinonasal Surgery in Low-Risk Patients

Patel

Shah

Vedula

et al. 2022

Am J Rhinol�Allergy

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Background Preoperative laboratory tests (PLTs) are often obtained prior to outpatient surgical procedures. The objective of this study is to examine the current practice of routine PLT in low-risk patients undergoing ambulatory endoscopic sinonasal surgery (ESS) and to assess whether such testing impacts surgical outcomes. Methods Patients undergoing ambulatory ESS were identified from the 2011 to 2018 NSQIP database. Low-risk patients were defined as American Society of Anesthesiologist class 1 or 2. PLTs were grouped into hematologic, chemistry, coagulation, and liver function tests. Chi-square analyses and independent samples t-tests were conducted to compare categoric and continuous variables, respectively. Results A total of 664 cases met the inclusion criteria, of which 419 (62.1%) underwent at least one PLT. Of these, the most frequent PLT obtained was a complete blood cell count (92.4%). Major complications occurred in 1.5% of patients. There were no statistically significant differences in overall postoperative complications between those with and without PLT ( P = .264). Specifically, no significant difference was seen in the incidence of postoperative bleeding ( P = .184), urinary tract infection ( P = .444), pulmonary embolism ( P = .444), or wound infection ( P = .701). On multivariable analyses, PLT status was not significantly associated with any complication ( P = .097) or unplanned readmission ( P = .898). Conclusions Our analysis did not reveal an association between the use of PLT and postoperative morbidity or unplanned readmission in low-risk patients undergoing outpatient ESS.

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“…In the eld of anaesthesia, PAC is well known to reduce patient anxiety (11), cancellation rate, length of hospital stay, costs (12), number of blood tests (13), mortality (14), and wound infections in addition to increasing patient satisfaction, and surgical volume and ow (12). However, a recent systematic review on the effectiveness of PAC found low quality prospective studies and highlighted the importance of high-quality research in this eld (15).…”

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confidence: 99%

Knowlege, safety, and teamwork: A qualitative study on the experience of anaesthesiologists and anaesthesia nurses working in the preanaesthesia assessment clinic

Kristoffersen

Opsal

Tveit

et al. 2022

Preprint

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Background: The preanaesthesia assessment clinic (PAC) has been shown to contribute to safe anaesthesia assessment in hospitals. In the PAC, patients are assessed with an interview and can also ask relevant questions about anaesthesia. The intention is to ensure that patients are comprehensively prepared for the surgery and hospital stay. Although earlier studies have assessed the effects of PAC, the experiences of anaesthesia personnel working in PACs remain unexplored. Thus, this study aimed to examine the experiences of anaesthesiologists and anaesthesia nurses working in PACs as well as to explore barriers and facilitators in this context.Methods: A descriptive qualitative approach was used to explore the experiences of anaesthesiologists and anaesthesia nurses working in PACs. Thirteen semi-structured interviews were conducted using face-to-face, telephone, or digital platforms in five hospitals in west, south, and north Norway between 2020 and 2021. The interviews were transcribed and thematically analysed based on Braun and Clarke’s six-steps reflexive approach. Results: Five themes and ten subthemes were identified through an active analysis process, including developing competence in clinical anaesthesia practice, identifying barriers and facilitators influencing collaboration and teamwork, improving patient safety and outcomes through structured assessment, and identifying other organisational factors affecting the delivery of healthcare to surgical patients. Conclusion: Working in the PAC contributed to competence development among the personnel. Additionally, teamwork was considered important for the proper functioning of the PAC. Patient safety was improved because of the structured assessment in PAC, with patients getting the opportunity to improve their knowledge and being more involved in the upcoming anaesthesia. Participants said they believed that the cancellation rate, delays in the operating room, and length of hospital stay for surgery patients were reduced.

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The impact of reduction of testing at a Preoperative Evaluation Clinic for elective cases: Value added without adverse outcomes

Cited by 18 publications

References 31 publications

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Modern preoperative evaluation in ambulatory surgery – who, where and how?

Utility of Preoperative Laboratory Testing for Ambulatory Endoscopic Sinonasal Surgery in Low-Risk Patients

Knowlege, safety, and teamwork: A qualitative study on the experience of anaesthesiologists and anaesthesia nurses working in the preanaesthesia assessment clinic

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