title: Utility of a preoperative assessment clinic in a tertiary care hospital.
abstract: OBJECTIVE
  To assess the utilisation rate of a preoperative assessment clinic and its impact on length of stay and discharge destinations.
  
  
  METHODS
  Retrospective case series with internal comparisons.
  
  
  METHODS
  A tertiary hospital in Hong Kong.
  
  
  METHODS
  All medical records of elective surgical admissions to a hospital in Hong Kong from April to June 2008 were retrieved. Medical records of patients who did not attend the preoperative assessment clinic were further reviewed by surgeons to assess if the patients could have been referred to the clinic.
  
  
  METHODS
  Total length of stay, preoperative and postoperative length of stay, and the discharge destinations of the patients attending and not attending the clinic were compared. RESULTS. In all, 640 patients underwent elective operations, of whom 22 (3%) patients were seen in the preoperative assessment clinic. In patients who had a major operation, the mean (standard deviation) total length of stays for clinic attenders and non-attenders were: 5.2 (3.6) versus 13.2 (18.8) days (P<0.001). The respective figures for preoperative and postoperative length of stay were: 1.3 (2.3) versus 4.5 (8.9) days (P=0.001), and 3.9 (2.9) versus 8.7 (14.5) days (P<0.001). For patients who had an intermediate operation, the respective mean (standard deviation) length of hospital stays were 2.4 (2.0) versus 7.3 (13.9) days (P=0.002) and the figures for postoperative length of stays were 1.3 (0.5) versus 4.5 (9.3) days (P=0.001). Surgeons had classified 108 (17%) of the cases as possible preoperative assessment clinic users. Among the latter, 71 (66%) had no special reason to stay in the hospital. The discharge destination was not associated with the use of preoperative assessment clinic for patients having major (Chi squared=0.18, P=0.912) or intermediate (Chi squared=0.34, P=0.468) operations.
  
  
  CONCLUSIONS
  Successful implementation of preoperative assessment clinic service requires close collaboration between surgeons, anaesthetists, clinicians, and also the re-engineering of health service delivery.
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong. cwkfrank@cuhk.edu.hk
authors.forename: Frank W K
authors.initials: FW
authors.lastname: Chan
authors.forename: Fiona  Y Y
authors.initials: F
authors.lastname: Wong
authors.forename: Y S
authors.initials: YS
authors.lastname: Cheung
authors.forename: P T
authors.initials: PT
authors.lastname: Chui
authors.forename: Paul B S
authors.initials: PB
authors.lastname: Lai
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies