在一家大型学术医疗中心开展、实施和评估远程医疗术前评估计划。
Development, Implementation, and Evaluation of a Telemedicine Preoperative Evaluation Initiative at a Major Academic Medical Center.
机构信息
From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California.
Connected Health, Information Services & Solutions, UCLA Health, Los Angeles, California.
出版信息
Anesth Analg. 2020 Dec;131(6):1647-1656. doi: 10.1213/ANE.0000000000005208.
BACKGROUND
With health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. In this article, we describe the implementation of a telemedicine-based anesthesia preoperative evaluation and report the program's patient satisfaction, clinical case cancellation rate outcomes, and cost savings in a large metropolitan area (Los Angeles, CA).
METHODS
This is a descriptive study of a telemedicine-based preoperative anesthesia evaluation process in an academic medical center within a large metropolitan area. In a 2-year period, we evaluated 419 patients scheduled for surgery by telemedicine and 1785 patients who were evaluated in-person.
RESULTS
Day-of-surgery case cancellations were 2.95% and 3.23% in the telemedicine and the in-person cohort, respectively. Telemedicine patients avoided a median round trip driving distance of 63 miles (Q1 24; Q3 119) and a median time saved of 137 (Q1 95; Q3 195) and 130 (Q1 91; Q3 237) minutes during morning and afternoon traffic conditions, respectively. Patients experienced time-based savings, particularly from traveling across a metropolitan area, which amounted to $67 of direct and opportunity cost savings. From patient satisfaction surveys, 98% (129 patients out of 131 completed surveys) of patients who were consulted via telemedicine were satisfied with their experience.
CONCLUSIONS
This study demonstrates the implementation of a telemedicine-based preoperative anesthesia evaluation from an academic medical center in a metropolitan area with high patient satisfaction, cost savings, and without increase in day-of-procedure case cancellations.
背景
随着医疗保健实践的整合、医疗系统地理范围的扩大以及移动通信的进步，人们对基于远程医疗的医疗咨询越来越感兴趣。自 2004 年以来，麻醉学在远程医疗咨询方面已经有了术前评估的经验，但大多数研究都是在农村地区进行的。在大都市地区，相关文献很少。在本文中，我们描述了基于远程医疗的麻醉术前评估的实施，并报告了在一个大城市（加利福尼亚州洛杉矶）中该程序的患者满意度、临床病例取消率结果和成本节约。
方法
这是一项关于在大都市地区的学术医疗中心中基于远程医疗的术前麻醉评估过程的描述性研究。在 2 年期间，我们通过远程医疗评估了 419 名计划手术的患者和 1785 名亲自评估的患者。
结果
远程医疗组和现场组的手术当天病例取消率分别为 2.95%和 3.23%。远程医疗患者避免了中位数往返驾驶距离 63 英里（Q1 24；Q3 119）和中位数节省时间 137（Q1 95；Q3 195）和 130（Q1 91；Q3 237）分钟，分别在早晚高峰时段。患者体验到了时间方面的节省，特别是在穿越大都市地区时，直接和机会成本节省了 67 美元。从患者满意度调查中，98%（131 名接受远程医疗咨询的患者中有 129 名完成了调查）的患者对他们的体验感到满意。
结论
本研究展示了在大都市地区的学术医疗中心实施基于远程医疗的术前麻醉评估，具有高患者满意度、成本节约，且不会增加手术当天病例取消率。
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