Patient-Centered Anesthesia Triage System Predicts ASA Physical Status

Abstract

PCATS serves as a useful, and valid, predictor of ASA PS classification. Thus, it may also serve as a tool to triage patients to an appropriate venue for preoperative assessment that can be utilized by nonclinical schedulers. Using a simple tool such as PCATS may help streamline the presurgical patient experience and improve clinic staff utilization.

Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic

“…Data were prospectively collected during both the pilot and implementation phases of the study. Patients are triaged for an in-person visit within the University of Florida Preoperative Anesthesia Clinic using the Patient-Centered Anesthesia Triage System criteria as defined by Enneking et al 14 Surgical specialties frequently using the Preoperative Anesthesia Clinic include abdominal surgery (included urology, pancreas and biliary surgery, colorectal surgery, and transplant surgeries), cardiothoracic surgeries (vascular and thoracic/cardiovascular surgeries), orthopedic surgeries (elective joint surgeries), gastroenterology (colonoscopies and sigmoidoscopies), neurological (laminectomies, craniectomies, deep brain stimulation, etc), and other (cataract removal, breast surgery, otolaryngology, and plastic reconstructive surgeries). Medical staff members did not complete the cognitive screening protocol with patients who were non-English speaking unless a certified interpreter was available during the testing or if they had marked visual or auditory deficits precluding testing.…”

Preoperative anaesthesia triage with a patient‐centred system—A prospective clinical study

“…), ≥5 prescription medications (3.) and high surgical complexity to be significantly associated with ASA III‐IV 4 . Surgical complexity was defined by our clinical setting and not included.…”

“…9.2, Cary, NC). We did not perform power calculation but used a previous study 4 with 300 patients as basis to define your sample, which was also the amount of data possible for us to collect in the study time frame. Medians with 95% range were used for descriptive statistics.…”

“…The increase in day surgery has changed the process of the preoperative anaesthetic evaluation with a need to eliminate unnecessary time and costs without compromising quality and safety of anaesthetic care 1 . The American Society of Anesthesiologists (ASA) score system estimate preoperative health status on a scale from I to VI, 2,3 and the system may guide planning of preoperative evaluation 4 . ASA suggest that for low to moderate complexity surgery, patients with severe systemic disease (ASA score ≥ III) are recommended anaesthetic assessment before the day of surgery, while more healthy subjects (ASA I‐II) can be assessed on or before the day of surgery 5 .…”

“…A preoperative patient-centred triage system was able to identify ASA III-IV patients with high sensitivity and resulting in a reduced number of preoperative visits by 39%. We identified multiple Pre-PAS criteria associated with ASA III-IV, but Pre-PAS ≥ 1 had a low specificity for ASA III-IV.Enneking et al reported that 87% of 300 patients with any positive criterion out of four criteria (BMI > 35 kg/m 2 , age > 80 years, ≥5 prescription medications and surgical complexity) were classified as ASA III-IV, and found that ≥5 daily prescription medications was the criterion with the strongest association to ASA class 4. Our study However, modifying other criteria such as insulin dependent diabetes, minimal daily morphine equivalent, specification of type of head-neck surgery could be the scope of future studies.Exclusion of some criteria, for example "use of any medication", could potentially be another way to increase specificity.…”