| Summary: | Preoperative assessment is an essential prerequisite to the safe conduct of anaesthesia. The work presented examines several aspects of the process of preoperative assessment and investigates some strategies to improve reliability.
The conduct of preoperative assessment, and the information which needs to be acquired in the process has been studied by several authors, and is the subject of guidelines and advisories published by various prominent associations and learned bodies. This literature is reviewed to establish the desired goals of the preoperative assessment,
The degree to which local practice is congruent with the various recommendations was investigated by means of a survey amongst local anaesthesia practitioners. To further understand anaesthetists expectations of the preoperative assessment, a series of semi-structured interviews were conducted and subjected to thematic analysis.
A healthcare failure modes and effects analysis (HFMEA) of the workings of a preoperative assessment clinic was carried out to predict likely points of failure. The actual functioning of the clinic in practice was further studied from two aspects. A survey of patient experience with the clinic was carried out, which revealed good overall performance, but with some issues regarding excessive waiting times and inadequate provision of information to the patients. An evaluation of the technical quality of the preoperative assessment was also conducted by soliciting feedback from attending anaesthetists. Issues reported included the failure to identify significant problems and failure to effectively communicate with the perioperative team. These issues were anticipated in the earlier HFMEA.
It was hypothesised that a cognitive aid to facilitate a structured approach to decision making and communication would improve the preoperative assessment process. With the input from a focus group, two body-systems based aids was constructed. These were assessed using a tabletop simulation of preoperative assessment. Improvement in reliability was observed. The effect of the aids on attending anaesthetist situation awareness, through better communication and memory formation, was also investigated using a tabletop simulation. Under these conditions no improvement could be identified.
Subjectively, anaesthetists found the aids useful for both preoperative patient assessment and peroperative case management. Junior doctors with no anaesthetic training, however, found the aids confusing.
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