Hostname: page-component-848d4c4894-v5vhk Total loading time: 0 Render date: 2024-06-14T00:03:42.117Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient flow in the preoperative assessment clinic

Published online by Cambridge University Press:  01 April 2008

G. M. Edward ,
S. Razzaq ,
A. de Roode ,
F. Boer ,
M. W. Hollmann ,
M. Dzoljic  and
L. C. Lemaire
G. M. Edward
Affiliation:
University of Amsterdam, Academic Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
S. Razzaq
Affiliation:
University of Amsterdam, Academic Medical Centre, Department of Medical Health Informatics, Amsterdam, Leiden, The Netherlands
A. de Roode
Affiliation:
University of Amsterdam, Academic Medical Centre, Leiden University, Leiden University Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
F. Boer
Affiliation:
University of Amsterdam, Academic Medical Centre, Leiden University, Leiden University Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
M. W. Hollmann*
Affiliation:
University of Amsterdam, Academic Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
M. Dzoljic
Affiliation:
University of Amsterdam, Academic Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
L. C. Lemaire
Affiliation:
University of Amsterdam, Academic Medical Centre, Department of Anaesthesiology, Leiden, The Netherlands
*
Markus W. Hollmann, Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: M.W.Hollmann@amc.uva.nl; Tel: +31 20 5663630; Fax: +31 20 6979441
Get access

Summary

Background and objective

Previous research has shown that a preoperative assessment clinic enhances hospital cost-efficiency. However, the differences in organization of the patient flow have not been analysed. In this descriptive study, we evaluated the consequences of the organization of the patient flow of a preoperative assessment clinic on its performance, by analysing two Dutch university hospitals, which are organized essentially differently.

Methods

In the final analysis, the study included 880 patients who visited either academic centre. The performance of the two preoperative assessment clinics was evaluated by measuring patient flow time, various procedure times and the total waiting time. Patients’ age, ASA physical status and any preoperative tests requested by the physician were also recorded.

Results

There was a significant difference in patient flow time between the two preoperative assessment clinics. More time was needed for the preoperative assessment when patients’ ASA class was higher. The patient flow time was longer when electrocardiogram and venepuncture were performed at the general outpatient laboratory than when they were performed at the preoperative assessment clinic due to longer waiting times. More tests were requested when they were performed at the preoperative assessment clinic.

Conclusions

This study shows that the organization of patient flow is an important aspect of the logistic processes of the preoperative assessment clinic. It might influence patient flow times as well as the number of preoperative tests requested. Together with other aspects of logistic performance, patient satisfaction and quality of medical assessment, patient flow logistics can be used to assess the quality of a preoperative assessment clinic.

Keywords

ORGANIZATION AND ADMINISTRATIONAMBULATORY CAREPREOPERATIVE CAREANAESTHESIOLOGY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 4 , April 2008 , pp. 280 - 286
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Aylin, P, Williams, S, Jarman, B, Bottle, A. Trends in day surgery rates. BMJ 2005; 331: 803.Google Scholar
2.Fischer, SP. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology 1996; 85: 196–206.Google Scholar
3.Pollard, JB, Zboray, AL, Mazze, RI. Economic benefits attributed to opening a preoperative evaluation clinic for outpatients. Anesth Analg 1996; 83: 407–410.Google Scholar
4.Starsnic, MA, Guarnieri, DM, Norris, MC. Efficacy and financial benefit of an anesthesiologist-directed university preadmission evaluation center. J Clin Anesth 1997; 9: 299–305.Google Scholar
5.Van Klei, WA, Moons, KG, Rutten, CL et al. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg 2002; 94: 644–649.Google Scholar
6.Pollard, JB, Garnerin, P, Dalman, RL. Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery. Anesth Analg 1997; 85: 1307–1311.Google Scholar
7.Ferschl, MB, Tung, A, Sweitzer, B, Huo, D, Glick, DB. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology 2005; 103: 855–859.Google Scholar
8.Lemmens, LC, Van Klei, WA, Klazinga, NS et al. The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals. Eur J Anaesthesiol 2006; 23: 962–970.Google Scholar
9. National good practice guidance on pre-operative assessment for inpatient surgery & day surgery. London: NHS Modernisation Agency, 2003.Google Scholar
10.Bower, P, Roland, M, Campbell, J, Mead, N. Setting standards based on patients’ views on access and continuity: secondary analysis of data from the general practice assessment survey. BMJ 2003; 326: 258.Google Scholar
11.Chen, KH, Chang, SR. Communicating outpatient perception to improve quality management. Qual Manag Health Care 2000; 8: 64–71.CrossRefGoogle ScholarPubMed
12.Dexter, F. Design of appointment systems for preanesthesia evaluation clinics to minimize patient waiting times: a review of computer simulation and patient survey studies. Anesth Analg 1999; 89: 925–931.Google Scholar
13.Hepner, DL, Bader, AM, Hurwitz, S, Gustafson, M, Tsen, LC. Patient satisfaction with preoperative assessment in a preoperative assessment testing clinic. Anesth Analg 2004; 98: 1099–1105.CrossRefGoogle Scholar
14.Blumenthal, D. Part 1. Quality of care – what is it? N Engl J Med 1996; 335: 891–894.Google Scholar
15.Spoeri, RK, Ullman, R. Measuring and reporting managed care performance: lessons learned and new initiatives. Ann Intern Med 1997; 127: 726–732.Google Scholar
16.Rubin, HR, Gandek, B, Rogers, WH, Kosinski, M, McHorney, CA, JrWare, JE. Patients’ ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. JAMA 1993; 270: 835–840.CrossRefGoogle ScholarPubMed
17.Kinley, H, Czoski-Murray, C, George, S et al. Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial. BMJ 2002; 325: 1323.CrossRefGoogle ScholarPubMed
18.Van Klei, WA, Hennis, PJ, Moen, J, Kalkman, CJ, Moons, KG. The accuracy of trained nurses in pre-operative health assessment: results of the OPEN study. Anaesthesia 2004; 59: 971–978.Google Scholar
19.Vissers, J. Selecting a suitable appointment system in an outpatient setting. Med Care 1979; 17: 1207–1220.Google Scholar
20.Elkhuizen, SG, van Sambeek, JR, Hans, EW, Krabbendam, KJ, Bakker, PJ. Applying the variety reduction principle to management of ancillary services. Health Care Manage Rev 2007; 32: 37–45.CrossRefGoogle ScholarPubMed