Telemed J E Health - Telemedicine pre-anesthesia evaluation: a randomized pilot trial.

Tópicos

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Resumo

JECTIVE: 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.

Resumo Limpo

jectiv preanesthesia evalu allow discoveri condit affect periop plan inadequ may associ delay cancel prevent advers event patient benefit will keep appoint telemedicin preanesthesia evalu may provid safe patient care reduc patient inconveni cost herein investig impact telemedicin preanesthesia evalu periop processessubject method singlecent prospect random trial adult schedul head neck surgeri loma linda univers medic center loma linda ca consent patient meet criteria telephon preanesthesia evalu random assign inperson telemedicin group primari outcom measur inadequ evalu caus surgic delay cancel secondari measur includ predict difficult airway manag concord physic examinationresult consent patient met criteria telephon screen five patient cancel surgeri none inadequ preanesthesia evalu thus random delay occur telemedicin patient await result perform outsid system miss document time visit less common telemedicin difficult airway manag predict equal low posit predict valu heart lung examin high concord day surgeri document patient provid high satisfi evalu modalitiesconclus telemedicin inperson evalu equival high patient provid satisfact telemedicin provid potenti patient time cost save benefit without day surgeri delay system prospect trial patient multipl surgic specialti clinic warrant

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