Martínez José Luis Gracia, Coca Miguel Ángel Morales, Del Olmo Rodríguez Marta, Vigoa Pablo, Gómez Jorge Martínez, Apellaniz Jorge Short, Coronel Catalina Paredes, García Marco Antonio Villegas, Serrano Juan José, Arcos Javier, Caramés Sánchez Cristina, Pfang Bernadette, Álvaro de la Parra Juan Antonio
Anesthesiology Department, General Villalba University Hospital, 28400 Madrid, Spain.
Information Technology and Systems Department, General Villalba University Hospital, 28040 Madrid, Spain.
J Clin Med. 2025 Apr 29;14(9):3093. doi: 10.3390/jcm14093093.
The increasing demand for elective surgery makes optimizing preoperative assessment a priority. Value-based healthcare aims to provide the highest value for patients at the lowest possible cost through various mechanisms, including reorganizing care into integrated practice units (IPUs). However, few studies have analyzed the effectiveness of implementing virtually led IPUs for preoperative assessment. We performed a retrospective observational cohort study including patients undergoing elective surgery at a teaching hospital in Madrid, Spain from 1 January 2018 to 31 December 2023, analyzing changes in surgical complications, efficiency, and patient satisfaction between the pre-implementation (2018-2019) and post-implementation (2020-2023) periods. Anesthesiologists' satisfaction with the virtual assessments was described. During the post-implementation period, preoperative assessment was reorganized as a virtually led IPU. At the IPU appointment, preoperative testing and physical (including airway) examinations were performed by a nurse anesthesiologist. The results were uploaded to the electronic health records, and asynchronous virtual anesthesiologist assessment using a store-and-forward approach was performed. Digital patient education was carried out over the Patient Portal mobile application. A total of 40,233 surgical procedures were included, of which 31,259 were from the post-intervention period. During the post-intervention period, no increase in surgical complications was observed, while same-day cancellations decreased from 4.3% to 2.8% of the total procedures ( < 0.001). The overall process time did not increase, despite the rising number of surgical procedures per year. Patient satisfaction improved. The median time to complete anesthesiologist assessment was significantly lower for virtual assessment (4.5 versus 10 min ( < 0.001), signifying estimated time savings of 716 person-hours per year. Anesthesiologists agreed that virtual assessment was more efficient than in-person evaluation, and half of the participants agreed that virtual preoperative care improved their work-life balance and reduced burnout. A digitally enhanced value-based model of preoperative care can improve efficiency and satisfaction metrics, reducing unnecessary costs and potentially improving the quality of care.
对择期手术的需求不断增加，这使得优化术前评估成为当务之急。基于价值的医疗保健旨在通过各种机制，以尽可能低的成本为患者提供最高价值，包括将护理重新组织为综合实践单元（IPU）。然而，很少有研究分析实施虚拟主导的IPU进行术前评估的有效性。我们进行了一项回顾性观察队列研究，纳入了2018年1月1日至2023年12月31日在西班牙马德里一家教学医院接受择期手术的患者，分析了实施前（2018 - 2019年）和实施后（2020 - 2023年）期间手术并发症、效率和患者满意度的变化。描述了麻醉医生对虚拟评估的满意度。在实施后阶段，术前评估被重新组织为虚拟主导的IPU。在IPU预约时，术前检查和体格（包括气道）检查由麻醉护士进行。结果上传至电子健康记录，并采用存储转发方法进行异步虚拟麻醉医生评估。通过患者门户移动应用程序开展数字患者教育。共纳入40233例手术，其中31259例来自干预后时期。在干预后时期，未观察到手术并发症增加，而当日取消手术的比例从占总手术的4.3%降至2.8%（<0.001）。尽管每年手术数量增加，但总体流程时间并未增加。患者满意度提高。虚拟评估完成麻醉医生评估的中位时间显著更低（4.5分钟对10分钟（<0.001），意味着每年估计节省716人时。麻醉医生一致认为虚拟评估比面对面评估更高效，一半的参与者认为虚拟术前护理改善了他们的工作与生活平衡并减少了职业倦怠。一种数字化增强的基于价值的术前护理模式可以提高效率和满意度指标，降低不必要的成本，并可能改善护理质量。
