Enhancing the utility of virtual surgical pre-assessment
During the COVID-19 pandemic, virtual pre-assessment was introduced for all elective and semi-urgent surgeries to maintain surgical clinical services in the authors' Trust. This mainly involved telephone pre-assessments, although occasionally video technology was used. This had to be managed and maintained at a distance with little or no training or established method. This article includes experiences of staff involved in a single tertiary centre, an assessment of the pros and cons of virtual pre-assessment and concludes with a set of recommendations to enhance the utility of the service for the future.
The main purpose of surgical pre-assessment is the risk/benefit evaluation and patient optimisation to minimise surgical and anaesthesia risks, to reduce the length of hospital stay and to enhance patient recovery (Khuri et al, 1995) on a platform of shared decision making (Stiggelbout et al, 2012). This is a major component of perioperative medicine dedicated to enhance surgical outcomes (Grocott and Pearse, 2012).
Traditionally, surgical pre-assessment has involved a focused history and a clinical assessment pertinent to the surgical specialty at a face-to-face meeting. It included a careful evaluation to identify those patients at high risk of complications. Additional investigations were organised when required, specialist opinions were requested in complex situations and the patient's condition optimised within the available timeframe, especially if the surgery was urgent.
Amid the increasing demand for operations and other invasive procedures, organising pre-assessment clinic appointments has become a strenuous burden due to limited hospital resources (Abbott et al, 2017). Therefore, telephone pre-assessment was developed as a tool that could reduce costs while improving patient experience and attendance and relieving overcrowding and patient anxiety at pre-assessment clinics (Lozada et al, 2016). However, little was known about its efficacy in achieving the goals of patient satisfaction (based on patient feedback) and surgical productivity (Yen et al, 2010).
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