Study Objective: To assess the effects of implementing an ambulatory and sa
me-day surgery preoperative evaluation patient triage system over a 3-year
period.
Design: Retrospective analysis of 63,941 ambulatory surgical patients prese
nting for elective surgery.
Setting: Tertiary care, academic medical institution.
Interventions: The following preoperative evaluation model components were
implemented over a 3-year period: HealthQuest(C), which is an outpatient pr
eoperative assessment computer program developed by the Department of Gener
al Anesthesiology; a general internal medicine clinic designated specifical
ly for preoperative evaluation and medical optimization; disease specific a
lgorithms for both preoperative patient assessment and management; and a pr
eoperative anesthesia clinic that no longer performs preoperative medical o
ptimization.
Measurements and Main Results: During the 3-year study period ambulatory an
d same-day surgical case volume increased 34.7%. A total of 50,967 patients
used HealthQuest(C) as part of their preoperative evaluation. Of these pat
ients 22,744 (35.6%) did not need to see an anesthesiologist until the day
of surgery as guided by both a computer-assigned HealthQuest(C) score and s
urgical classification scheme. Also, 41,197 patients were evaluated in our
anesthesia preoperative clinic with a cost per evaluation of $24.86, which
increased only 0.9% per year. lit addition, both patient interview time and
patient dissatisfaction with the preoperative process decreased over the 3
-year period. There were 20,088 patient encounters in the general internal
medicine clinic for patient medical evaluation and optimization. The averag
e monthly preoperative surgical delay rate decreased 49% during the study p
eriod. Finally, significant monetary saving resulted due to decreased unnec
essary laboratory testing.
Conclusions: Efficient, cost-effective patient cam can be Provided by using
this preoperative evaluation model. Some institutions may find portions of
this preoperative model applicable to their current situation. (C) 2000 by
Elsevier Science Inc.