PRIMARY OBJECTIVE - To compare pre-operative investigations and referral practices with the Indian Society of Anaesthesiology guidelines and to evaluate additional resources utilised as a result of it. - To find the prevalence and impact of abnormal test result on peri-operative anaesthesia management.
SECONDARY OBJECTIVE - To find no. of unnecessary investigation in pre-op period and evaluate resources utilised as a result of it. - To find patient satisfaction related to pre-operative evaluation. - Any other observation arising during the study.
INTRODUCTION & RATIONAL OF THE STUDY: The practice and scope of preanaesthesia evaluation have changed dramatically in recent years, from the time when preoperative evaluation and preparation was the responsibility of surgeons, or other medical specialists, to the current status where anaesthesiologists assume the leadership role in the assessment and optimization of patients who are being prepared for surgery. (1,2) For many years it has been usual practice in many hospitals to test apparently healthy patients preoperatively for unsuspected conditions or some hidden problem that might affect management. Such investigations include haemogram, blood glucose tests, liver and kidney function test, ECG, chest x-rays etc.(3) The main purpose of preoperative investigations is to provide additional diagnostic and prognostic information to supplement the clinical history of a patient with the aim to provide better peri-operative management, but these investigations are criticised as having little impact on peri-operative outcomes and increases cost, causes delay and increases laboratory load.(4) The task forces of the Indian Society of Anaesthesiologists (ISA)(5) have provided guidance on the use of pre�’operative laboratory tests. These guidelines are against the practice of routine pre�’operative laboratory tests but, the tradition of routine preoperative testing is still prevalent. As they are Indian protocols, they may be relevant to our setups The present study will be aimed to compare the pre-operative laboratory investigation ordered with the Indian Society of Anaesthesiologist guidlines
PROCEDURE PLANNED Patients attending Pre-Anaesthesia Clinic for pre�’anaesthesia evaluation and risk stratification before planned elective surgeries fulfilling inclusion criteria will be included in the study. Their demographic parameters, date of arrival in PAC, ASA status, Grade of surgery according to ISA guidelines will be recorded. Number of investigation already performed before arriving in PAC and their results in terms of normal and abnormal tests will be noted. Tests will be considered as abnormal if they are not within normal limits as assigned by institutional laboratory. Based on the guidelines, the tests will considered as required or not required. Number of newly diagnosed comorbidity (disease) from the investigations will also be noted. Numbers of abnormal tests and their impact will be expressed in absolute number as well as percentage scale These patients will then be traced on the day before surgery when they undergo pre-operative evaluation again, here patients satisfaction towards pre-operative clinic will be accessed. Then on the day of surgery, patient’s plan of anaesthetic management will be noted. An abnormal test result will be said to be impactful if it resulted in referral, delay, further investigations, retesting as well as changes in plan of anaesthetic management. Impact will be considered to be significant only if it led to a change in the perioperative anaesthetic management (i.e., postponing the elective case for further optimisation, changes in the on�’going management, altering the anaesthetic procedure and monitoring plan.) Cost analysis will be done for every test that will be considered not necessary based on ISA guidelines. Total cost of investigations will be calculated based on the rates fixed by Central Government Health Services and the financial implications on the patient and the institute will be analysed. The investigations done for diagnostic purposes will be excluded from this study. Any disease specific investigation which could be expected from patients history or clinical examination will not be considered impact as these will not be routine investigation. The data will be collected by a fixed designated anaesthesiologist for the entire duration of the study. However, designated anaesthesiologist will not filter out any investigations. The designated anaesthesiologist (data collector) also will not intervene to modify the PAC process conducted by other colleague of the same rank. No surgeons or the anaesthesiologists will be informed about the study to remove bias. The patients who will be directly evaluated by the designated anaesthesiologist will not included in the study Data collection and methods: Pre-designed Pre-structured proforma will be used for collecting the data. The data will also be entered to master chart.
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