Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California 92350, USA.
Telemed J E Health. 2013 Mar;19(3):211-6. doi: 10.1089/tmj.2012.0132. Epub 2013 Feb 5.
Pre-anesthesia evaluation allows discovery of conditions affecting perioperative planning, but when inadequate it may be associated with delays, cancellations, and preventable adverse events. Not all patients who could benefit will keep appointments. Telemedicine pre-anesthesia evaluation may provide for safe patient care while reducing patient inconvenience and cost. Herein we investigate the impact of telemedicine pre-anesthesia evaluation on perioperative processes.
This was a single-center prospective randomized trial in 200 adults scheduled for head and neck surgery at Loma Linda University Medical Center, Loma Linda, CA. Consenting patients not meeting criteria for telephone pre-anesthesia evaluation were randomly assigned to the in-person or telemedicine group. The primary outcome measure was inadequate evaluation caused surgical delay or cancellation. Secondary measures included prediction of difficult airway management and concordance of physical examination.
After consent, 40 patients met criteria for telephone screening. Five patients canceled surgery, none for inadequate pre-anesthesia evaluation; thus 155 were randomized. Delay occurred in 1 telemedicine patient awaiting results performed outside our system. Missing documentation at the time of the visit was less common for telemedicine. Difficult airway management was predicted equally but had low positive predictive value. Heart and lung examinations were highly concordant with day of surgery documentation. Patients and providers were highly satisfied with both evaluation modalities.
Telemedicine and in-person evaluations were equivalent, with high patient and provider satisfaction. Telemedicine provides potential patient time and cost saving benefits without more day of surgery delay in our system. A prospective trial of patients from multiple surgical specialty clinics is warranted.
麻醉前评估可发现影响围手术期计划的情况，但如果评估不充分，可能会导致延迟、取消手术和可预防的不良事件。并非所有受益的患者都会预约。远程医疗麻醉前评估可以在减少患者不便和成本的同时，为患者提供安全的护理。在此，我们研究了远程医疗麻醉前评估对围手术期流程的影响。
这是在加利福尼亚州洛马林达大学医学中心进行的一项针对 200 名计划接受头颈部手术的成年人的单中心前瞻性随机试验。不符合电话麻醉前评估标准的同意患者被随机分配到面对面或远程医疗组。主要观察指标是评估不充分导致手术延迟或取消。次要观察指标包括预测困难气道管理和体格检查的一致性。
在同意后，有 40 名患者符合电话筛选标准。有 5 名患者取消了手术，但均不是因为麻醉前评估不充分；因此，共有 155 名患者被随机分组。有 1 名远程医疗患者在等待我们系统外进行的检查结果时出现延迟。在就诊时，远程医疗的文档缺失情况较少。困难气道管理的预测结果相同，但阳性预测值较低。心肺检查与手术当天的文档记录高度一致。患者和提供者对两种评估方式均非常满意。
远程医疗和面对面评估是等效的，患者和提供者的满意度都很高。在我们的系统中，远程医疗不会导致手术当天的更多延迟，但可以为患者节省时间和成本。有必要对来自多个外科专科诊所的患者进行前瞻性试验。
