Teleconsultation for preoperative evaluation during the coronavirus disease 2019 pandemic

Abstract

BACKGROUND During the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings. OBJECTIVE This study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events. DESIGN Implementation study. SETTING A tertiary care university hospital in Germany from April 2020 to October 2020. PATIENTS One hundred and eleven patients scheduled for elective surgery. INTERVENTION Patients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey. MAIN OUTCOME MEASURES Primary endpoints were medical and technical feasibility, user satisfaction and time savings. RESULTS For 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery. CONCLUSION Telepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic. TRIAL REGISTRATION NCT04518514, ClinicalTrials.gov

Patient satisfaction with divided anesthesia care

“…On the one hand, implementation of preoperative anesthesia wards is an inherent part of modern anesthesia practice (divided care), and it is very unlikely that this direction will change. On the contrary, preoperative evaluation by teleconsultation will probably strengthen this in the near future [ 29 , 30 ]. Nevertheless, we are confronted with the fact that a considerable number of patients, in our case 40%, still assess continuity of care by the same physician as important [ 27 ].…”

“…From a patient’s perspective, this means that the same anesthetist handles preoperative evaluation and informed consent, intraoperative anesthesia care, and postoperative visits on the ward [ 24 ]. However, the inclusion of preoperative anesthesia units as an integral part of modern anesthesia practice and the implementation of preoperative evaluation by teleconsultation [ 29 , 30 ] has promoted the “divided care” practice. This, however, might lead to patient reports of reduction in the continuity of care, and to decreased patient satisfaction [ 17 ].…”

Exploring Patient Perspectives Surrounding Telemedicine Versus In-Person Preoperative Visits

“…Preoperative visits with anesthesiologists show that telemedicine is medically feasible, and satisfaction rates for these visits are high for patients and health care providers. 3 Similarly, patients and surgeons reported high degrees of satisfaction for telemedicine postoperative visits. 4 While telemedicine has been rapidly integrated into the U.S. health care system, the patient experience and decision-making process regarding telemedicine versus in-person preoperative visits has not been adequately explored.…”

“…Telemedicine is now used for a diverse range of appointment types, including surgical evaluation. Preoperative visits with anesthesiologists show that telemedicine is medically feasible, and satisfaction rates for these visits are high for patients and health care providers 3 . Similarly, patients and surgeons reported high degrees of satisfaction for telemedicine postoperative visits 4 …”

Modern preoperative evaluation in ambulatory surgery – who, where and how?

“…Waiting times can be significantly shortened in virtual meetings and patient satisfaction is high [33]. During the COVID-19 pandemic, teleconsultations were able to reduce the transmission risk posed by on-site visits [34].…”