The anaesthesia consult clinic: does it matter which anaesthetist sees the patient?

PURPOSE

The objectives of this multicentre survey were: first to ascertain whether the preoperative evaluation performed by anaesthetists in the preadmission anaesthesia consultation clinic (PACC) is influenced by the knowledge that they will or will not be the patient's attending anaesthetist; and second to determine the agreement among anaesthetists with regard to investigations requested.

METHODS

A postal survey was designed in two different versions, equal numbers of which were sent to 522 anaesthetists in 39 Canadian hospitals. The anaesthetists contacted were asked to consider how they would investigate two hypothetical patients in a PACC. One version of the survey stated that they would be the attending anaesthetist for the first patient, but not for the second patient (group A). In the second version the situation was reversed (group B).

RESULTS

A total of 281 eligible replies were received. For each of the two patients the decision to order an echocardiogram, cardiac stress test, arterial blood gas analysis, pulmonary function tests, or internal medicine referral was not affected by the knowledge that the respondent would or would not be the patient's attending anaesthetist. Within each of the two groups there was very little consensus with regard to the ordering of laboratory tests.

CONCLUSION

The extent of investigation in the PACC scenarios was not affected by knowledge of whether or not the consulting anaesthetist would be the attending anaesthetist in the operating room. However, there was minimal agreement among anaesthetists concerning the preoperative evaluation of the patients, regardless of who would be the anaesthetist on the day of operation. Efficiency in preoperative evaluation could be increased if anaesthetists saw their own patients in the PACC, or if clinical guidelines for patient assessment were introduced by departments.