TY - JOUR
T1 - Telemedicine pre-anesthesia evaluation
T2 - A randomized pilot trial
AU - Applegate, Richard L.
AU - Gildea, Brett
AU - Patchin, Rebecca
AU - Rook, James L.
AU - Wolford, Brent
AU - Nyirady, Janice
AU - Dawes, Terry Ann
AU - Faltys, John
AU - Ramsingh, Davinder S.
AU - Stier, Gary
N1 - 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.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - 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. Subjects and 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. Copyright © 2013, Mary Ann Liebert, Inc. 2013.
AB - 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. Subjects and 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. Copyright © 2013, Mary Ann Liebert, Inc. 2013.
KW - information management
KW - telecommunications
KW - telemedicine
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Male
KW - Patient Satisfaction
KW - Anesthesia/methods
KW - Pilot Projects
KW - Time Factors
KW - Sensitivity and Specificity
KW - Remote Consultation/methods
KW - Adult
KW - Female
KW - Aged
KW - Airway Management/methods
KW - Preoperative Period
UR - http://www.scopus.com/inward/record.url?scp=84875151181&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875151181&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/33768066-fde7-312f-9b94-96ae91201a45/
U2 - 10.1089/tmj.2012.0132
DO - 10.1089/tmj.2012.0132
M3 - Article
C2 - 23384334
SN - 1530-5627
VL - 19
SP - 211
EP - 216
JO - Telemedicine and e-Health
JF - Telemedicine and e-Health
IS - 3
ER -