They then went home and completed an online ... Statistical analysis with Excel (R2) and R (logistical ... POAC before they complete the online assessment ... units.pdf. 5. Miller RD. Miller's Anaesthesia. Eight Edition ed: Churchill Livingstone; ...
The Evaluation of an Online Preoperative Assessment Tool O’Shea J, Coleman M , Mahdy S, Corbett M, Curley G.
THE PROBLEM Triaging Preop Assessment Clinics Preoperative Assessment reduces risk of poor perioperative outcome and reduces cost in a specific group of perioperative candidates.[1][2][3] The HSE and NHS do not have the resources to see everybody at POACs.[4] Triage by surgeons results in inconsistent referrals to POAC.[5]
My Solution: Anaesthesia Preoperative Assessment Tool
A web application that asks patients a series of 22 weighted MCQs about their medical background.
My Solution: Anaesthesia Preoperative Assessment Tool
A web application that asks patients a series of 22 weighted MCQs about their medical background. Uses a Previously Validated Model to assign an ASA grade to each patient.
My Solution: Anaesthesia Preoperative Assessment Tool
A web application that asks patients a series of 22 weighted MCQs about their medical background. Uses a Previously Validated Model to assign an ASA grade to each patient. Displays the results to the doctor via a Secured Online Dashboard.
Ethical Approval ! GDPR Compliant ! Written Informed Consent !
Study Methodology Prospective Cohort Trial Patients were recruited during their visit to POAC. Participants underwent traditional preoperative assessment by consultant anaesthetist (gold standard). They then went home and completed an online assessment on APAT. The results of both assessments were compared (ASA grade, need for non standard investigation, need for intervention). Statistical analysis with Excel (R2) and R (logistical regression analysis).
RESULTS 60 patients invited
55 enrolled & consented
22 completed assessments
APAT correlates with ASA grade
Sum of weighted answers against the ASA grade assigned by consultant anaesthetist.
APAT predicts patient risk
ASA 1&2 = Low Risk ASA 3&4 = High Risk
AUC = 0.9825
APAT predicts the need for Non-Standard Investigations
“Standard” -ECG -CXR -FBC -U&E -LFT -Coag
AUC = 0.8077
APAT predicts the need for Intervention/Referral
AUC = 0.7193
LIMITATIONS ✓ N = 22
-> Attrition Bias -> Logistical Reg. with Training and Test
✓ Confounding Bias introduced by seeing patients in POAC before they complete the online assessment ✓ Model does not consider BMI & Airway assessment
FAQs & Questions?
Questions?
Whats Next?
References:
Improvements to the algorithm (in progress) and another Prospective Cohort with a larger sample.
1. Davies SJ, Wilson RJT. Preoperative optimization of the high-risk surgical patient. BJA: British Journal of Anaesthesia. 2004;93(1):121-8.
Will you make any money?
2. Meka A, Okoro U, Jaffe T, Cron D, Semaan D, Hwang C et al. What Should Pre-operative Clinics Do to Optimize Patients for Major Surgery?. Michigan Journal of Medicine. 2016;1(1).
No, APAT would be free for any HSE or NHS hospital to use (running cost $7 per month).
Could it replace POAC?
3. Snowden CP, Anderson H. Preoperative optimization: rationale and process is it economic sense? Current Opinion in Anaesthesiology. 2012;25(2):210-6.
No, it’s a tool designed to triage patients into and away from POAC when you can’t see everyone.
4. Health Services Executive. Model of Care for Pre-Admission Units. HSE; 2014. Available from: https://www.hse.ie/eng/services/publications/clinicalstrategy-and-programmes/anaesthesia-model-of-care-for-preadmissionunits.pdf
The software is GDPR compliant as long as patients are consented correctly before their data is stored, and that the hospital delete the data appropriately.