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Correspondence  |   January 1997
Anesthesia Preoperative Evaluation Clinic: III
Author Notes
  • Critical Care Research Unit, Department of Anaesthetic and Intensive Care, Liverpool Hospital, NSW 2170, Australia.
Article Information
Correspondence
Correspondence   |   January 1997
Anesthesia Preoperative Evaluation Clinic: III
Anesthesiology 1 1997, Vol.86, 260-261. doi:
Anesthesiology 1 1997, Vol.86, 260-261. doi:
To the Editor:-The preanesthetic clinic described by Fischer [1] highlights how anesthesiologists have played a key role in redesigning and developing more effective systems to manage elective surgical patients. In the current trend of delivering cost-effective, customer-focused, and evidence-based practice in Australia, we developed a Perioperative Service. [2] Integral to this service is the referral of high-risk patients to a preanesthetic clinic. We highlight important differences between the two systems and report on preliminary, results on 4,707 elective surgical patients (June 1995 to February 1996).
In our approach, a proportion of patients (31%) are referred to a clinic using a predefined criteria (major surgical procedure, patient health questionnaire identified a potential problem, surgeon's request, or patient's request). Irrespective of the patient's American Society of Anesthesiologists (ASA) physical status, all patients attending our preanaesthetic clinic are reviewed by an anesthesiologist, with nursing support for patient education. We emphasize that the clinic assessments, usually scheduled 2 weeks before surgery, are complementary to, and do not replace, the traditional preanesthetic visit.
Recent developments in our service include obtaining information from the patient's general practitioner about recent laboratory tests (to prevent duplication) and how well chronic medical conditions have been under control. Discharge arrangements with community nurses, general practitioners, and ancillary services are also planned before admission to our hospital. These steps ensure continuity of patient care after hospital discharge.
Although preanesthetic clinics have been established in various institutions, [1–3] the outcome of patients after a clinic intervention has not been examined. Our preliminary data suggest that patients who are not referred to the clinic were 1.64 (95%CI: 1.15–2.38) times more likely to be inadequately prepared for surgery than patients referred to the clinic. However, clinic patients were 1.44 (95%CI: 1.20–1.73) times more likely to experience an intraoperative event than nonclinic patients after adjusting for patient admission category, level of preoperative preparation, anesthetic technique, and ASA physical status. The implication of these results is that anesthesiologists still need to be vigilant, even after a patient has been assessed at a preanesthetic clinic.
Meaningful comparisons of the efficacy of preanesthetic clinic between institutions will require the use of risk adjustment methods and clearly defined outcomes. There is accumulating evidence to suggest that preanesthetic clinics are associated with decreased length of hospital stay, [2,4] lower hospital costs incurred, [4] decrease in laboratory tests performed, [1] reduction in the number of cancellations on the day of surgery, [1–3] and improved operating theatre efficiency. [1–3] Although anesthesiologists have focused on the above process indicators to support the existence of preanesthetic clinics, the question “Does the preanesthetic clinic make a difference to patient outcome” remains to be fully explored.
Anna Lee, M.P.H., Ken M. Hillman, F.A.N.Z.C.A., Critical Care Research Unit, Department of Anaesthetic and Intensive Care, Liverpool Hospital, NSW 2170, Australia.
(Accepted for publication October 10, 1996.)
REFERENCES
Fischer SP: Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology 1996; 85:196-206.
Kerridge R, Lee A, Latchford E, Beehan SJ, Hillman KM: The perioperative system: A new approach to managing elective surgery. Anaesth Intensive Care 1995; 23:591-6.
Conway JB, Goldberg J, Chung F: Preadmission anaesthesia consultation clinic. Can J Anaesth 1992; 39:1051-7.
Boothe P, Finegan BA: Changing the admission process for elective surgery: An economic analysis. Can J Anaesth 1995; 42:391-4.