Redefining the preoperative evaluation process and the role of the anesthesiologist

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.