Starsnic M A, Guarnieri D M, Norris M C
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA 19107-5092, USA.
J Clin Anesth. 1997 Jun;9(4):299-305. doi: 10.1016/s0952-8180(97)00007-x.
To study the effectiveness of an anesthesiologist-directed preadmission evaluation center (PEC) in our institution.
I: Preoperative test costs were measured on two sets of patients undergoing same-day surgery. II: Rate of cancellation was measured on all patients undergoing same-day surgery in a subsequent one-year time period.
The PEC, short procedure unit, and same-day admission unit of a university hospital.
I: 3,062 male and female patients undergoing same-day surgery between January 1, 1992, and August 31, 1992. II: 9,454 male and female patients undergoing same-day surgery between July 1, 1993, and June 30, 1994.
Age, ASA physical status, type of surgery performed, and tests ordered were recorded in two groups of same-day surgical patients. Group S had testing primarily ordered by surgeons, augmented by the anesthesiologists in the PEC. Group A had testing primarily ordered by the anesthesiologists in the PEC, but surgeons could still order tests they felt necessary. On the day of surgery, the attending anesthesiologist recorded any additional testing that was required or would have altered intraoperative management. In a follow-up study, cancellations of same-day surgical patients were recorded for a one-year period.
I: With the exception of complete blood counts with differentials, significantly fewer tests were ordered in Group A than Group S. These changes produced an average cost savings of $20.89 per patient. There were no recorded cancellations or apparent alterations in intraoperative management attributable to inadequate testing. II: Of the 9,454 same-day procedures from 7/1/93 to 6/31/94, 66 were cancelled on the day of the procedure. None of the patients seen in the PEC were cancelled due to causes possibly preventable by a PEC, unlike the cases of 4 patients who had not been evaluated in teh PEC and were cancelled.
A PEC, in which the anesthesiologist primarily orders preoperative tests and approves patients' readiness for surgery, is both an efficient and cost-effective system.
研究我院麻醉医生主导的入院前评估中心（PEC）的有效性。
I：对两组接受当日手术的患者的术前检查费用进行测量。II：在随后的一年时间内，对所有接受当日手术的患者的取消手术率进行测量。
一所大学医院的PEC、简短手术科室和当日入院科室。
I：1992年1月1日至1992年8月31日期间接受当日手术的3062名男性和女性患者。II：1993年7月1日至1994年6月30日期间接受当日手术的9454名男性和女性患者。
记录两组当日手术患者的年龄、美国麻醉医师协会（ASA）身体状况、所进行的手术类型和所开具的检查项目。S组的检查主要由外科医生开具，PEC的麻醉医生会进行补充。A组的检查主要由PEC的麻醉医生开具，但外科医生仍可开具他们认为必要的检查。在手术当天，主麻医生记录任何所需的额外检查或可能改变术中管理的检查。在一项随访研究中，记录了一年时间内当日手术患者的取消手术情况。
I：除了不同分类的全血细胞计数外，A组开具的检查明显少于S组。这些变化使每位患者平均节省费用20.89美元。没有因检查不足而导致取消手术或术中管理出现明显改变的记录。II：在1993年7月1日至1994年6月31日的9454例当日手术中，有66例在手术当天取消。PEC评估的患者中没有因PEC可能预防的原因而取消手术的情况，与4例未在PEC评估而取消手术的患者不同。
由麻醉医生主要开具术前检查并批准患者手术准备情况的PEC是一个高效且具有成本效益的系统。
