What Should Pre-operative Clinics Do to Optimize Patients for Major Surgery?

Meka, Arjun P.; Okoro, Uchenna; Jaffe, Todd A.; Cron, David C.; Semaan, Daniel Z.; Hwang, Charles; Papin, Joseph; Palazzolo, William C.; Barrett, Meredith

doi:10.3998/mjm.13761231.0001.114

Cited by 3 publications

(7 citation statements)

References 27 publications

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“…Our findings on health and personal care optimisation are in line with today's recommendations to prevent complications by improving patient information and preparations before surgery [3,24]. Patients are rarely informed in a timely manner about the benefits of lifestyle changes [6] and most patients participating in this study believed it was too late to change lifestyle weeks before surgery. If patients optimise their own health before surgery by exercising, improving nutritional status, or discontinuing smoking, alcohol and other substances they can reduce complications [6,7,30,31].…”

Section: Discussionsupporting

confidence: 78%

“…Combining patient's surgical safety checklist with existing programs such as the ERAS program might improve patient's compliance to the program as well as further reduce complications, and hospitalisation time. Several surgical complication prevention programs are based on providers giving information and patients adhering to the programs [6,7,[13][14][15]19]. The aim for a patient's surgical safety checklist is to encourage patients to take more responsibility for their own safety, by ensuring that they have received and understood the information provided to them as well as helping them to prepare before and after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organisation (WHO) and European patient organisations endorse patient involvement in safety [1,2]. Patient involvement in self-care and safety is widely discussed [1,[3][4][5][6][7]. Patients are willing to participate, but this depends largely on the healthcare system creating opportunities that promote and allow patient involvement [2,5,8].…”

Section: Introductionmentioning

confidence: 99%

“…How patients can be involved in applying checklists has been recommended, but has not been significantly explored [3,24]. A checklist for patients to use might enhance patientphysician communication, increase patient's participation in their own safety and optimise patient health [3,6,24].…”

Section: Introductionmentioning

confidence: 99%

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Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Harris

Søfteland

Moi

et al. 2020

BMC Health Serv Res

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Background: Patients' involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients' use of surgical checklist. To identify risk elements of complications based on patients' and healthcare workers' experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist. Method: A qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis.Results: Safety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist. Conclusion:A broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors. Trail registration: The study is registered as part of a clinical trial in ClinicalTrials.gov: NCT03105713.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Harris

Søfteland

Moi

et al. 2020

BMC Health Serv Res

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“…It has been reported that the probabilities of small airway narrowing and increased bronchial reactivity should be considered during administration of anesthesia to patients who smoke cigarettes [3].It may lead to various complications ranging from intraoperative hypoxia to bronchospasm, delayed recovery, postoperative pneumonia, delayed wound healing and extended hospital stay [4,5]. Therefore, it is of great importance to advise smoking cessation and to motivate patients to quit smoking within the scope of preoperative evaluation [4,6,7]. In preoperative patients, determining the general condition of the patient, reducing anxiety, making the patient aware of the risk factors, and making recommendations to reduce these risk factors are among the responsibilities of anesthesiologists [7].…”

mentioning

confidence: 99%

Quitting smoking before surgical interventions and its relationship to health literacy

Özgünay

Demirci

Eminoğlu

et al. 2019

The European Research Journal

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Objectives: The aim of our study was to evaluate the effect of health literacy (HL) level and smoking dependence of patients on their compliance with advice given by the physicians in anesthesia polyclinics on giving up smoking. Methods: This prospective study included 165 smokers. HL was evaluated by The European Health Literacy (HLS-EU). Nicotine dependence was measured by Fagerstrom test for nicotine dependence (FTND). Patients were advised not to smoke and their carbon monoxide levels in expired air were measured before on the operation day. Results: The number of patients smoking on the day of surgery was significantly higher among females (p = 0.001). While the HL was lower, the FTND scores (p = 0.006), daily cigarette consumption (p < 0.001) and years of cigarette smoking (p = 0.002) were found to be significantly higher. Fewer number of days between the polyclinic interview and the surgery date were positively correlated with compliance with the advice to give up smoking (p = 0.011). Conclusion: Since the number of patients continuing to smoke cigarettes was high, it was concluded that verbal advice on giving up smoking is not enough and that other more effective measures are needed to ensure patient compliance. The reminder of 'quit smoking' on the day very close to the surgery may help more patients to stop smoking on that day.

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Evaluation of an online preoperative assessment tool

et al. 2020

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Triaging patients into and away from preoperative assessment clinics remains a challenge. Anaesthesia Preoperative Assessment Tool (APAT) is a web application that delivers an online 22 question survey to patients at home, and uses an artificially intelligent algorithm to stratify patient risk and identify the need for non routine preoperative investigation and intervention. We assess APATs accuracy and patient acceptability in this prospective observational study. Patients were recruited at preoperative assessment clinic, where they were assessed by a consultant anaesthetist. Anaesthetist (ASA) grade, need for nonstandard investigation and intervention were recorded (gold standard). Patients were invited to complete an APAT assessment on their PC or smartphone at home, and the results of both assessments compared. 22 patients completed conventional clinical assessment by consultant anaesthetist and online assessment by APAT. APAT score correlates with clinicians ASA grade (rτ=0.6075, p=0.0008). APAT predicts patient risk group (misclassification rate of 0%, Area Under the Curve (AUC)=0.9825). APAT predicts the need for additional investigation (AUC=0.8077) and preoperative intervention (AUC=0.7193). Online assessment was acceptable to 92% of patients. Our findings support the hypothesis that APAT accurately predicts patients perioperative risk and predicts the need for investigation and intervention. Further studies are needed to confirm that APAT may be used to identify ASA 1 and 2 patients who could safely bypass preoperative assessment clinic.

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What Should Pre-operative Clinics Do to Optimize Patients for Major Surgery?

Cited by 3 publications

References 27 publications

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Quitting smoking before surgical interventions and its relationship to health literacy

Evaluation of an online preoperative assessment tool

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