An online patient-completed preop system

The Royal College of Anaesthetists, Guidelines for the Provision of Anaesthesia Services (GPAS) for Pre-operative assessment and preparation 2017 has the objective of describing current best practice in pre-operative assessment and preparation for anaesthesia and surgery.

It states a 'comprehensive pre-operative assessment and preparation service is fundamental to high-quality, safe practice. The service is part of the responsibility of the anaesthetist as a perioperative physician. The goal of pre-assessment is to ensure an excellent patient- and family-centred experience with shared decision-making embedded throughout the process. Appropriate education and professional development for staff should be available. Training in pre-operative assessment and assessment of competence is essential in this specialist area. This service is an integral part of the anaesthetic pathway and should be fully funded.

There are two main components to pre-operative assessment and preparation. The first is based on the provision of a safe and appropriate anaesthesia. This is primarily a safety check and patient communication process most often carried out on the day of surgery by the anaesthetist involved in the case. The second is the concept of the anaesthetist as the perioperative physician and it is in this capacity that the second component is undertaken. It is now broadly accepted that there is a need to assess the chance of harm and benefit afforded by any surgical or anaesthetic intervention and

this information should be communicated to the patient. This should facilitate the shared decision-making process, which will lead to the selection of appropriate intra-operative and post-operative care that takes into account the patient’s personal preferences and values.

The aim is to ensure the patient is fully informed and ready for surgery. This will involve a health check and possibly optimisation of their health and current therapies. It involves planning with the patient their admission to hospital and discharge after surgery. This will help prevent cancellations on the day of surgery and lead to a better patient experience.'

Within the Royal College of Anaesthetists guidance are the following statements:-

• Documentation and communication of information on preop preparation are essential. Electronic systems should be considered to enable the capture and sharing of information, support risk identification and allow data to be collected and available for audit and research purposes.

• Information from the patient’s preop assessment should be readily available, ideally as part of an electronic patient record so information is easy to transfer between locations and to enable data collection for later analysis.

• Where possible, it is preferable for one-stop arrangements to be implemented so patients can attend preop assessment during the same hospital visit as their surgical outpatient assessment.

• Information (for patients) can be provided in a range of formats, including written leaflets and on the internet. Details of websites that provide reliable, impartial and evidence-based information should be made available to patients when appropriate.

• For 1,000 patients, the following minimum staffing is required: 0.6 registered nurses and 0.3 healthcare assistants. This staffing to patient ratio is based on 80% of patients as day cases and 20% as in-patients assuming day case patients have a 30-minute nurse consultation and in-patients have a 45-minutes.

 How Can it Improve your Current PreOp Assessment Process?

MyPreOp® has many advantages over traditional paper-based face-to-face assessments. One of the most useful features is the Clinical Summary output page, the page automatically highlights any areas of concern prompting further investigation, making MyPreOp® a powerful screening tool. The output also includes ICD10 codes for any co-morbidities and suggested ASA grades.

MyPreOp® is fantastic for minimising inconvenience to the patient (potential for DNAs), decreasing the 'Referral to Treatment Time' and reducing demand on hospital resources, saving time and money.

The key benefits of MyPreOp® as an innovative preop system for assessments are:

For Staff

• Staff can concentrate on clinical decision making and processes rather than information gathering

• Staff in different departments can access the information electronically e.g. surgeon, anaesthetist, PreOp team

For Patients

• Minimises patient appointments at the hospital

• Provides time to carefully consider answers in detail as the program is patient completed

• Enhanced understanding through web links to detailed and concise information

For the Hospital

• Optimises use of staff time; enabling them to process more assessments

• Staff can spend time with more complex patients or those with concerns, improving the patient experience

• Reduces expenditure on paper records and information leaflets (including storage space)

For Information Technology services

• No software installation or maintenance is required

• MyPreOp® is cloud-based so integrates quickly and easily with existing IT

For Information Governance

• Data is held and shared via secure Microsoft Azure cloud servers hosted in the UK

• Patients complete and share their own assessments through their secure Ultramed accounts

To provide Patient Information

• Contains links to relevant and current online resources which minimises the requirement and associated printing costs of patient information leaflets.

Cost Saving

• Saves time and money by increasing capacity and reducing preoperative resource requirements

• Enables nurses to focus on key clinical decision making

• ICD 10 codes for co-morbidities automatically generated, optimising income