Zafar Jill E, Chan Kathleen T, Ryder Lori J, Duffy Andrew J, Dai Feng, Carr Zyad J, Charchaflieh Jean G
Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA.
Yale New Haven Hospital, New Haven, CT 06510, USA.
Healthcare (Basel). 2023 Jan 19;11(3):309. doi: 10.3390/healthcare11030309.
: Preoperative patient evaluation and optimization in a preoperative evaluation center (PEC) has been shown to improve operating room (OR) efficiency and patient care. However, performing preoperative evaluation on all patients scheduled for surgery or procedure would be time- and resource-consuming. Therefore, appropriate patient selection for evaluation at PECs is one aspect of improving PEC efficiency. In this study, we evaluate the effect of an enhanced preoperative evaluation process (PEP), utilizing a nursing triage phone call and information technology (IT) optimizations, on PEC efficiency and the quality of care in bariatric surgery patients. We hypothesized that, compared to a traditional PEP, the enhanced PEP would improve PEC efficiency without a negative impact on quality. : The study was a retrospective cohort analysis of 1550 patients from January 2014 to March 2017 at a large, tertiary care academic health system. The study was a before/after comparison that compared the enhanced PEP model to the traditional PEP model. The primary outcome was the efficiency of the PEC, which was measured by the reduction of in-person patient visits at the PEC. The secondary outcome was the quality of care, which was measured by delays, cancellations, and the need for additional testing on the day of surgery (DOS). : The enhanced PEP improved the primary outcome of efficiency, as evident by an 80% decrease in in-person patient visits to the PEC. There was no reduction in the secondary outcome of the quality of care as measured by delays, cancellations, or the need for additional testing on the DOS. The implementation of the enhanced PEP did not result in increased costs or resource utilization. : The enhanced PEP in a multi-disciplinary preoperative process can improve the efficiency of PEC for bariatric surgery patients without any decrease in the quality of care. The enhanced PEP process can be implemented without an increase in resource utilization and can be particularly useful during the COVID-19 pandemic.
术前评估中心（PEC）对患者进行术前评估及优化已被证明可提高手术室（OR）效率及患者护理质量。然而，对所有安排手术或操作的患者进行术前评估会耗费时间和资源。因此，在PEC进行评估时合理选择患者是提高PEC效率的一个方面。在本研究中，我们评估了强化术前评估流程（PEP），利用护理分诊电话及信息技术（IT）优化，对PEC效率及减重手术患者护理质量的影响。我们假设，与传统PEP相比，强化PEP可提高PEC效率且不会对质量产生负面影响。
该研究是对2014年1月至2017年3月期间在一家大型三级医疗学术健康系统的1550例患者进行的回顾性队列分析。该研究是一种前后对比，将强化PEP模型与传统PEP模型进行比较。主要结局是PEC的效率，通过减少患者到PEC的现场就诊次数来衡量。次要结局是护理质量，通过手术当天（DOS）的延误、取消手术及额外检查需求来衡量。
强化PEP提高了效率这一主要结局，患者到PEC的现场就诊次数减少了80%即证明了这一点。以延误、取消手术或DOS时的额外检查需求衡量的护理质量这一次要结局并未降低。强化PEP的实施并未导致成本增加或资源利用增加。
多学科术前流程中的强化PEP可提高PEC对减重手术患者的效率，且护理质量不会有任何下降。强化PEP流程的实施无需增加资源利用，在2019冠状病毒病大流行期间可能特别有用。
