title: Telemedicine pre-anesthesia evaluation: a randomized pilot trial.
abstract: OBJECTIVE
  Pre-anesthesia evaluation allows discovery of conditions affecting perioperative planning, but when inadequate it may be associated with delays, cancellations, and preventable adverse events. Not all patients who could benefit will keep appointments. Telemedicine pre-anesthesia evaluation may provide for safe patient care while reducing patient inconvenience and cost. Herein we investigate the impact of telemedicine pre-anesthesia evaluation on perioperative processes.
  
  
  METHODS
  This was a single-center prospective randomized trial in 200 adults scheduled for head and neck surgery at Loma Linda University Medical Center, Loma Linda, CA. Consenting patients not meeting criteria for telephone pre-anesthesia evaluation were randomly assigned to the in-person or telemedicine group. The primary outcome measure was inadequate evaluation caused surgical delay or cancellation. Secondary measures included prediction of difficult airway management and concordance of physical examination.
  
  
  RESULTS
  After consent, 40 patients met criteria for telephone screening. Five patients canceled surgery, none for inadequate pre-anesthesia evaluation; thus 155 were randomized. Delay occurred in 1 telemedicine patient awaiting results performed outside our system. Missing documentation at the time of the visit was less common for telemedicine. Difficult airway management was predicted equally but had low positive predictive value. Heart and lung examinations were highly concordant with day of surgery documentation. Patients and providers were highly satisfied with both evaluation modalities.
  
  
  CONCLUSIONS
  Telemedicine and in-person evaluations were equivalent, with high patient and provider satisfaction. Telemedicine provides potential patient time and cost saving benefits without more day of surgery delay in our system. A prospective trial of patients from multiple surgical specialty clinics is warranted.
authors: Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California 92350, USA. rapplegate@llu.edu
authors: Richard L
authors: RL
authors: Applegate
authors: Brett
authors: B
authors: Gildea
authors: Rebecca
authors: R
authors: Patchin
authors: James L
authors: JL
authors: Rook
authors: Brent
authors: B
authors: Wolford
authors: Janice
authors: J
authors: Nyirady
authors: Terry-Ann
authors: TA
authors: Dawes
authors: John
authors: J
authors: Faltys
authors: Davinder S
authors: DS
authors: Ramsingh
authors: Gary
authors: G
authors: Stier
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D057234:Preoperative Period; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors