Journal of Anesthesia and Surgery
Adopting Information Management Based Joint Preoperative Assessment and Risk Stratification Model to Save Surgical Care Cost
Assistant Professor, Department of Anaesthesiology, Andaman and Nicobar Island Institute of Medical Sciences & GB Pant Hospital, Port Blair, India
Habib Md Reazaul Karim, Department of Anaesthesiology, ANIIMS & GB Pant Hospital, Port Blair, India, Tel: 919612372585; E-mail: email@example.com
Karim, H.M.R. Adopting Information Management Based Joint Preoperative Assessment and Risk Stratification Model to Save Surgical Care Cost. (2017) J Anesth Surg 4(1): 1- 2.
© 2017 Karim, H.M.R. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
KeywordsPreoperative assessment; Surgical care cost; Information Management
Preoperative assessment and risk stratification is an integral part of anesthetic care which is one of the various duties of an anesthesiologist. Laboratory investigation is an important element in the process of preoperative assessment and risk stratification. Unfortunately,
Efforts have been made by different health care societies and authorities to guide the preoperative testing before elective surgeries. American Society of Anaesthesiologists and the National Institute
In preoperative risk assessment, the history and physical examination are the strongest predictors of perioperative complications. Ancillary tests should be indicated on an individual basis if the history and physical examination indicate towards some underlying disease. However, studies show that the practice has not changed to ‘individualized / patients characteristic’ from ‘routine’ and that preoperative testing is more strongly associated with provider practice patterns than with patient characteristics.
A study reviewing data from National Surgical Quality Improvement Program database found that neither laboratory testing nor abnormal results were associated with postoperative complications. Many a time, we try to find some hidden abnormality by using routine preoperative testing. What we need to realize is that routine screening does not
It has been found that most of the patients who attend
1) Patient comes to contact in primary health centre (PHC) / emergency department (ED) / outpatient department (OPD) (history, physical examination and clinical findings, differential diagnosis (DD), bed
2) If it appears that there is need for surgery of surgical consultation → refer to surgeon (in case patient attended PHC or ED)
3) (Day 1) Surgeon examines patient, reviews
4) (Day 1 / same day) Anesthesiologist sitting in the PAC room or in the joint consultation room examines the patient, assess the functional status clinically by assessing metabolic equivalents of task (MET), reviews
5) (By same day or day 2) OPD patients attend laboratory or testing
6) (Day 2 or 3) Surgeon reviews the updated
7) (Day 2 or 3) Anaesthesiologist reviews the updated
8) Surgeon / Hospital give the date of admission for surgery based on available slot / protocol.
This proposed model was developed after observing the ED, OPD, PAC and surgical care delivery process in three government sector tertiary care hospitals of India. Referral from PHC was also taken
To conclude, it is high time to abandon the practice of routine preoperative tests and adopt individualized investigations. Surgeons and anesthesiologists need to work together to get rid of the burden of unindicated / unnecessary investigations. Adopting an information management system based joint preoperative assessment is likely to help in this.
Acknowledge and Clarification: The author is thankful to Prof (Dr.) Ramesh MT, Head of the department of General Surgery of the same institute for reviewing the proposed model. The proposed model is the idea or concept of the author and it was developed after observing the ED, OPD, PAC and surgical care delivery process in three government sector tertiary care hospitals as well PHC delivery and referral services of those areas.
Conflict of interest: None
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