Department of Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland
University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Open Qual. 2022 Oct;11(4). doi: 10.1136/bmjoq-2022-001959.
Preoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions required a careful balance between ensuring best medical practices and maintaining safety by minimising patient face-to-face attendance in the hospital. Based on the successful implementation of telemedicine (TM) in other medical specialties and its feasibility in the preoperative context, this study aimed to develop, implement and evaluate a high-quality virtual preoperative anaesthetic assessment process.
The three-step model for improvement was used. The specific, measurable, actionable, relevant, time aim (step 1) and measures for improvement (step 2) were defined at the onset of the project. The plan-do-study-act tool was used for the structured implementation of improvement interventions (step 3) in three phases. Data relating to virtual and in-person referrals, assessments, did-not-attend (DNA) rate, consultation time, day of surgery delays and cancellations, and service-user and provider experience surveys were recorded prospectively.
A total of 2805 patients were assessed in the preoperative anaesthetic assessment clinic between July 2020 and March 2021. The mean rate of virtual preoperative assessments was 50% (SD ±10) (1390/2805). 0.1% (30/2805) were inappropriately referred on the alternative pathway. The DNA rate was 0.4% (8/1398) and 3% (43/1458) for virtual and in-person pathways, respectively. The mean consultation times for virtual and in-person attendance were 19 (SD ±7) and 31 (SD ±13) min, respectively. There were five same-day surgery cancellations and one delay due to medical reasons. When asked about their experience with the virtual assessment, both service users and providers reported high satisfaction, minimal technical difficulties and shared concerns about limited opportunities for physical examination.
This is one of the first implementational studies to comprehensively outline the feasibility of TM in preoperative anaesthetic assessment during COVID-19.
术前风险因素的识别和优化被广泛认为是择期手术护理的黄金标准，对于降低发病率和死亡率至关重要。COVID-19 公共卫生限制要求在确保最佳医疗实践和通过最大限度地减少患者在医院的面对面就诊来确保安全之间进行仔细平衡。基于远程医疗（TM）在其他医学专业中的成功实施及其在术前环境中的可行性，本研究旨在开发、实施和评估高质量的虚拟术前麻醉评估流程。
使用改进的三步模型。在项目开始时定义了具体、可衡量、可操作、相关和有时限的目标（步骤 1）和改进措施（步骤 2）。在三个阶段中，使用计划-执行-研究-行动工具对改进干预措施进行了结构化实施（步骤 3）。前瞻性记录了与虚拟和当面转诊、评估、未到场（DNA）率、咨询时间、手术日延迟和取消以及服务使用者和提供者体验调查相关的数据。
2020 年 7 月至 2021 年 3 月期间，共有 2805 名患者在术前麻醉评估诊所接受了评估。虚拟术前评估的平均比例为 50%（SD±10）（1390/2805）。0.1%（30/2805）的患者在替代途径上被不适当转诊。虚拟和当面途径的 DNA 率分别为 0.4%（8/1398）和 3%（43/1458）。虚拟和当面就诊的平均咨询时间分别为 19（SD±7）和 31（SD±13）分钟。由于医疗原因，有 5 例当天手术取消和 1 例延迟。当被问及他们对虚拟评估的体验时，服务使用者和提供者都报告了高度的满意度、最小的技术困难以及对体检机会有限的共同关注。
这是在 COVID-19 期间全面概述 TM 在术前麻醉评估中可行性的首批实施研究之一。
