More than 25,000 surgical procedures are scheduled annually at the Perelman Center for Advanced Medicine (PCAM) and the Hospital of the University of Pennsylvania (HUP) as elective day of surgery admissions, or outpatient procedures.
Studies have shown that a preoperative anesthesia evaluation can increase care coordination among providers, and decrease perioperative complications, morbidity, and mortality, benefiting patients, providers, and hospitals. However, in the current state, 99% percent of the patients scheduled for surgical procedures at PCAM and HUP will not discuss the details of their medical history with an anesthesiologist until the day of their scheduled surgery.
New information elicited during day-of-surgery interviews frequently results in delays and cancellations - an estimated 25% of which are preventable.
Peer institutions attempt to address this complex issue with costly, resource-intensive preoperative anesthesia clinics that require an additional office-based evaluation for patients before their procedure.
A team led by Marc Royo, MD, MBA set out to explore the feasibility of a virtual preoperative anesthesia clinic to determine if it would be possible to extract the value of a physical preoperative anesthesia clinic without disrupting the current patient workflow or adding additional cost.
The team started by asking anesthesiologists what they need to know to approve a patient for surgery and guarantee safety. Using that information, they developed a patient-centered preoperative assessment survey to be completed once the patient is scheduled for surgery. Through multiple iterations, questionnaire content and phrasing were adjusted to enable patients to complete the survey without any clinician guidance.
Based on patient responses, a scoring system was created to identify potentially high-risk patient factors so that appropriate patients could be triaged into a queue for review by an anesthesiologist.
In its final iteration, it took patients less than four minutes to complete the survey without any guidance from a clinician.
More importantly, the tool proved successful in gathering the critical information anesthesiologists need to know weeks before the day of surgery. During the pilot, approximately 1 in 10 patients triggered a high-risk alert and required intervention in their preoperative preparation.
Interventions included adjustments in pain medications, the use of CPAP machines postoperatively to decrease the incidence of adverse respiratory events, as well as changes in operating location to allow for the availability of higher acuity resources.
Based on the success of the pilot, the PreOp+ screening tool is currently in-use at the Pre-Admission Testing Center of the Perelman Center for Advanced Medicine. The team is also working to integrate the tool via myPennMedicine into a virtual Department of Anesthesiology and Critical Care welcome page that aims to decrease anxiety around the perioperative experience. The page will also help capture patients who either do not obtain their pre-admission testing at PCAM or do not undergo preoperative laboratory testing.
At scale, PreOp+ will serve as a virtual anesthesia preoperative evaluation clinic for surgical practices across Penn Medicine.