Redefining the preoperative evaluation process and the role of the anesthesiologist.
OBJECTIVE
To assess the effects of implementing an ambulatory and same-day surgery preoperative evaluation patient triage system over a 3-year period.


METHODS
Retrospective analysis of 63,941 ambulatory surgical patients presenting for elective surgery.


METHODS
Tertiary care, academic medical institution.


METHODS
The following preoperative evaluation model components were implemented over a 3-year period: HealthQuest, which is an outpatient preoperative assessment computer program developed by the Department of General Anesthesiology; a general internal medicine clinic designated specifically for preoperative evaluation and medical optimization; disease specific algorithms for both preoperative patient assessment and management; and a preoperative anesthesia clinic that no longer performs preoperative medical optimization.


RESULTS
During the 3-year study period ambulatory and same-day surgical case volume increased 34.7%. A total of 50,967 patients used HealthQuest as part of their preoperative evaluation. Of these patients 22,744 (35.6%) did not need to see an anesthesiologist until the day of surgery as guided by both a computer-assigned HealthQuest score and surgical 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. In 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 average monthly preoperative surgical delay rate decreased 49% during the study period. Finally, significant monetary saving resulted due to decreased unnecessary laboratory testing.


CONCLUSIONS
Efficient, cost-effective patient care can be provided by using this preoperative evaluation model. Some institutions may find portions of this preoperative model applicable to their current situation.
Parker
B M
BM
Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. parkerb1@ccf.org
Tetzlaff
J E
JE
Litaker
D L
DL
Maurer
W G
WG
D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D000776:Anesthesiology / Q000191:economics / Q000592:standards; D006801:Humans; D011300:Preoperative Care / Q000191:economics / Q000592:standards