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Anesthesiology Clinics Mar 2016Preoperative evaluation clinics have been shown to enhance operating room efficiency, decrease day-of-surgery cancellations, reduce hospital costs, and improve the... (Review)
Review
Preoperative evaluation clinics have been shown to enhance operating room efficiency, decrease day-of-surgery cancellations, reduce hospital costs, and improve the quality of patient care. Although programs differ in staffing, structure, financial support, and daily operations, they share the common goal of preoperative risk reduction in order for patients to proceed safely through the perioperative period. Effective preoperative evaluation occurs if processes are standardized to ensure clinical, regulatory, and accreditation guidelines are met while keeping medical optimization and patient satisfaction at the forefront. Although no universally accepted standard model exists, there are key components to a successful preoperative process.
Topics: Anesthesia; Humans; Preoperative Care; Preoperative Period; Risk Assessment
PubMed: 26927735
DOI: 10.1016/j.anclin.2015.10.002 -
Anesthesiology Clinics Mar 2016Routine preoperative testing is not cost-effective, because it is unlikely to identify significant abnormalities. Abnormal findings from routine testing are more likely... (Review)
Review
Routine preoperative testing is not cost-effective, because it is unlikely to identify significant abnormalities. Abnormal findings from routine testing are more likely to be false positive, are costly to pursue, introduce a new risk, increase the patient's anxiety, and are inconvenient to the patient. Abnormal findings rarely alter the surgical or anesthetic plan, and there is usually no association between perioperative complications and abnormal laboratory results. Incidental findings and false positive results may lead to increased hospital visits and admissions. Preoperative testing needs to be done based on a targeted history and physical examination and the type of surgery.
Topics: Diagnostic Tests, Routine; Electrocardiography; Humans; Preoperative Care; Preoperative Period; Risk Assessment
PubMed: 26927738
DOI: 10.1016/j.anclin.2015.10.005 -
Anesthesiology Clinics Mar 2016Preoperative consultation is an important intervention that likely has most benefits for intermediate-risk to high-risk patients undergoing major surgery. Consultation... (Review)
Review
Preoperative consultation is an important intervention that likely has most benefits for intermediate-risk to high-risk patients undergoing major surgery. Consultation rates are likely increasing and there is significant practice variation in the use of consultation. Consultations should be available within a well-organized and coordinated process of preoperative assessment. Preoperative consults should be accessible to anesthesia and surgical teams involved in the procedure and to the providers involved in postoperative care. The role of preoperative consultation should evolve as a rational approach and emerge as a value-based service. New payment methodologies are likely to facilitate appropriate use of this important resource.
Topics: Delivery of Health Care; Humans; Perioperative Care; Preoperative Care; Referral and Consultation; Surgical Procedures, Operative
PubMed: 26927736
DOI: 10.1016/j.anclin.2015.10.003 -
Anesthesiology Clinics Jun 2018To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the... (Review)
Review
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.
Topics: Comorbidity; Humans; Perioperative Care; Preoperative Care; Quality of Health Care; Risk Assessment
PubMed: 29759287
DOI: 10.1016/j.anclin.2018.01.006 -
Pediatric Neurology Nov 2020Antiepileptic drugs afford good seizure control for approximately 70% of individuals with epilepsy. Epilepsy surgery is extremely helpful for appropriate individuals... (Review)
Review
Antiepileptic drugs afford good seizure control for approximately 70% of individuals with epilepsy. Epilepsy surgery is extremely helpful for appropriate individuals with drug resistance. Since antiquity, trephination was a crude and invasive technique to manage epilepsy. The late 1800s saw the advent of a more evidence-based approach with attempts to define seizure foci and determine areas of function. Seizure localization initially required direct brain stimulation during surgery before resection. Fortunately, improved knowledge of seizure semiology and advancements in preoperative investigations have enabled epilepsy specialists to better analyze the benefit of seizure reduction versus risk of functional harm. This preoperative phase and the investigative techniques used to analyze surgical candidacy will be discussed in this article.
Topics: Child; Congresses as Topic; Drug Resistant Epilepsy; Humans; Neuroimaging; Neurophysiological Monitoring; Neurosurgical Procedures; Preoperative Care
PubMed: 32920308
DOI: 10.1016/j.pediatrneurol.2020.05.010 -
Anesthesiology Clinics Dec 2018Value in health care has been described as quality divided by cost, where quality is the sum of patient outcomes and experience. A well-run preoperative evaluation... (Review)
Review
Value in health care has been described as quality divided by cost, where quality is the sum of patient outcomes and experience. A well-run preoperative evaluation clinic (PEC) offers many opportunities to improve the value of the care delivered to patients by reducing the associated costs and improving the quality of care. Certain patient education and medical optimization strategies initiated in the PEC clinic are linked to an improvement in patients' long-term health outcomes. When designing a PEC, it is important to address the PEC's mission and scope with all stakeholders early in the process.
Topics: Ambulatory Care Facilities; Facility Design and Construction; Humans; Preoperative Care
PubMed: 30390773
DOI: 10.1016/j.anclin.2018.07.001 -
Best Practice & Research. Clinical... Jun 2020Point-of-care ultrasound (POCUS) is a widely used diagnostic tool, especially in emergency and critical care medicine, and it is increasingly being used in the... (Review)
Review
Point-of-care ultrasound (POCUS) is a widely used diagnostic tool, especially in emergency and critical care medicine, and it is increasingly being used in the perioperative setting. Its specific role in preoperative assessment of patients, however, has not yet been defined. While some data show innovative use of the technique in the preoperative setting, higher-level evidence to underscore potential advantages is still limited. We review and discuss a range of POCUS examinations which can potentially help anaesthesiologists in the preoperative clinic decide whether to perform additional testing, can assist in selecting the best anaesthetic approach, and can support perioperative and postoperative monitoring.
Topics: Airway Management; Humans; Physical Examination; Point-of-Care Systems; Preoperative Care; Ultrasonography
PubMed: 32711837
DOI: 10.1016/j.bpa.2020.04.010 -
Best Practice & Research. Clinical... Jun 2020
Topics: Humans; Hypertension; Obesity; Opioid Epidemic; Preoperative Care
PubMed: 32711823
DOI: 10.1016/j.bpa.2020.04.009 -
Nursing Standard (Royal College of... May 2016Essential facts According to data gathered by the Health and Social Care Information Centre, the NHS in England completed 10.6 million operations in 2012/13, compared...
Essential facts According to data gathered by the Health and Social Care Information Centre, the NHS in England completed 10.6 million operations in 2012/13, compared with 6.61 million a decade before - a rise of 60%. Over the same period, pre-operative assessment has changed radically, with most people seen well in advance of their surgery in a pre-operative assessment unit. While the number of routine tests for young, healthy people having minor surgery has reduced significantly, there remains a concern that some unnecessary tests continue to be requested, says the National Institute for Health and Care Excellence (NICE).
Topics: Diagnostic Tests, Routine; Patient Education as Topic; Practice Guidelines as Topic; Preoperative Care; State Medicine; United Kingdom; Unnecessary Procedures
PubMed: 27206180
DOI: 10.7748/ns.30.37.16.s16 -
British Journal of Hospital Medicine... Feb 2019
Topics: Exercise Therapy; Humans; Physical Fitness; Postoperative Care; Preoperative Care; Surgical Procedures, Operative
PubMed: 30746987
DOI: 10.12968/hmed.2019.80.2.118