Computer-assisted phone-based pre-operative medical assessment by non-clinicians - a comparison with outpatient medical consultation

Patient health status ranged in complexity, with an average of 6 (min-max: 0-17) significant health history items per patient, and with 23% of patients being ASA 3 or greater Overall, the quality provided by both forms of assessment was virtually identical, with 94.4% and 94.7% of the relevant history items identified by Anaesthetist and CAA, respectively, being accurate and sufficiently well described. The CAA performed less well in areas which relied upon physical examination, such as airway assessment and hitherto undiagnosed cardiovascular issues discovered in clinic, such as asymptomatic cardiac abnormalities. The panel considered that, with the information provided by the CAA, 49.5% of the patients required no further pre-assessment and could have bypassed outpatient clinic assessment and been seen by an anaesthetist on the day of surgery. The sensitivity of the CAA to correctly assign patients to bypass outpatient clinic was 100%, the specificity was 98%. 1% of patients were wrongly designated as being suitable for day of surgery assessment based upon CAA alone. Conclusions CAA is an effective tool for generating a clinically useful and very detailed patient medical history, and for identifying peri-operative issues for both anaesthetists and surgeons. Further, it provides a cost-effective tool for pre-screening patients to identify the need for further examination and assessment, specific preoperative investigations, specialist work-up prior to the day of surgery, and referral to a surgical facility with capacity relevant to their needs. Such strategies provide potential large cost savings through optimal use of increasingly limited resources.