Subramani Yamini, Querney Jill, Singh Priyanka, Zhang Yifan, Fochesato Lee-Anne, Fatima Nida, Wood Natasha, Nagappa Mahesh
Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Nursing, London Health Sciences Centre, Western University, London, ON, Canada.
JMIR Perioper Med. 2024 Jul 25;7:e57541. doi: 10.2196/57541.
The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments.
This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow.
A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days.
The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions.
The quality improvement process significantly enhanced the institution's preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.
入院前诊所（PAC）在围手术期护理中至关重要，在手术前提供评估、教育并优化患者状况。在新冠疫情期间，由于缺乏视频会诊基础设施，PAC改为采用电话问诊。虽然疫情显著增加了虚拟护理的使用，包括视频预约作为面对面会诊的替代方式，但我们的PAC尚未将视频会诊用于术前评估。
本研究旨在开发、实施术前视频会诊并将其纳入PAC工作流程。
采用计划-执行-研究-行动（PDSA）方法开展一项前瞻性质量改进项目。该项目聚焦于在加拿大安大略省伦敦市的伦敦健康科学中心和圣约瑟夫医疗保健机构的PAC中开发、实施和整合虚拟视频会诊。系统收集数据以监测接受视频会诊的患者数量，解决患者流程问题，并提高视频会诊的比例。分析PAC、外科医生办公室和患者之间的沟通情况以持续改进。解决技术难题，并简化流程以方便在预约日进行视频通话。
PAC团队包括医学、麻醉、护理、药学、职业治疗和物理治疗等专业人员，为手术患者提供术前评估和教育，每年在3个医院地点进行约8000次会诊。在最初的PDSA循环之后，干预措施持续将视频会诊利用率提高到17%表明取得了积极进展。随着PDSA循环3的开始，早期利用率显著飙升至29%。这一上升趋势持续，在该循环后期虚拟视频会诊利用率达到38%。这一较高水平在2023年全年持续保持，凸显了我们干预措施的持续成功。
质量改进过程显著增强了该机构的术前视频会诊工作流程。通过了解PAC内部的复杂性，采取了战略干预措施来整合视频会诊，同时不影响效率、士气或安全性。该项目凸显了通过精心整合虚拟护理技术在医疗服务提供方面实现变革性改进的潜力。
