title: A call centre and extended checklist for pre-screening elective surgical patients – a pilot study.
abstract: BACKGROUND
  Novel approaches to preoperative assessment and management before elective surgery are warranted to ensure that a sustainable high quality service is provided. The benefits of a call centre incorporating an extended preoperative electronic checklist and phone follow-up as an alternative to a clinic attendance were examined.
  
  
  METHODS
  This was a pilot study of a new method of patient assessment in patients scheduled for elective non-cardiac surgery and who attended a conventional preoperative clinic. A call centre assessment, using a Computer-assisted Health Assessment by Telephone (CHAT), paper review by an anaesthetist, and a follow-up phone call if the anaesthetist wished more information, preceded the conventional preoperative clinic. Summaries from the call centre and clinic assessments were independently produced. The times spent by call centre staff were recorded. The 'procedural anaesthetist' (who provided anaesthesia for each patient's actual surgery/procedure) documented an opinion on whether the call centre assessment alone would have been sufficient to bypass the preoperative clinic if the patient were hypothetically undergoing laparoscopic cholecystectomy. This opinion was also sought from a panel of four senior anaesthetists, based on patient summaries from both the call centre and preoperative clinic, but expanded to three hypothetical operations of different complexity – cataract removal, laparoscopic cholecystectomy, and total hip replacement.
  
  
  RESULTS
  Call centre assessment followed by clinic attendance was studied in 193 patients. The mean time for CHAT was 19.8 (SD 7.5) minutes and, after review of CHAT summaries, anaesthetists telephoned 45.6% of cases for follow-up information. The mean time spent by anaesthetists on summary review and phone calls was 3.8 (SD 3.9) minutes. Procedural anaesthetists considered 89% of the patients under their care suitable to have bypassed the preoperative clinic if they were to have undergone cholecystectomy. The panel of senior anaesthetists judged 95-97% of patients suitable to have bypassed preoperative clinic for cataract surgery, 81-85% for cholecystectomy and 79-82% for hip replacement.
  
  
  CONCLUSIONS
  A call centre to pre-screen elective surgical patients might substantially reduce patient numbers attending preoperative anaesthetic assessment clinics. Further studies to assess the quality of such an approach are indicated.
  
  
  BACKGROUND
  ANZCTR ACTRN12614000199617.
authors.affiliation: Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, North Terrace, 5005, South Australia. guy.ludbrook@adelaide.edu.au.|Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, North Terrace, 5000, South Australia. guy.ludbrook@adelaide.edu.au.
authors.forename: Guy
authors.initials: G
authors.lastname: Ludbrook
authors.affiliation: Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, North Terrace, 5000, South Australia. richard.seglenieks@alumni.adelaide.edu.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Seglenieks
authors.affiliation: Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, North Terrace, 5000, South Australia. shonaosborn@gmail.com.
authors.forename: Shona
authors.initials: S
authors.lastname: Osborn
authors.affiliation: Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, North Terrace, 5005, South Australia. cliff.grant@adelaide.edu.au.
authors.forename: Cliff
authors.initials: C
authors.lastname: Grant
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods; D000777:Anesthetics / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D002387:Cataract Extraction / Q000379:methods; D057189:Checklist; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D013689:Telephone; D013997:Time Factors
chemical_list: D000777:Anesthetics