Authors (including presenting author) :
Joey K.M. Wai(1), Katherine Liu(1)(2), Charmaine K.L. Chu(1), Alice Y.Y, Ma(1), Doris M. Y. Lee(1), Ka Wai Leung(1)
Affiliation :
(1) Department of anaesthesiology, pain medicine and operating services, United Christian Hospital, Hong Kong
(2) Department of Anaesthesiology, Queen Mary Hospital, Hong Kong
Introduction :
The emergence of COVID-19 pandemic has led to a substantial number of postponements of elective surgery in effort to prioritise both human and medical resources for infection control measures and medical care of patients suffering from COVID-19 infection. In our hospital, around 75% of patients for surgery have their pre-anaesthetic assessment completed in an out-patient clinic in hospital. Telemedicine could be an interim measure to manage extra patient case load for pre-anaesthetic reassessment while minimising patient attendance to clinic in hospital. The Department of Anaesthesiology, Pain Medicine and Operating Services of the United Christian Hospital has set up a pilot programme of teleconsultation for pre-anaesthetic assessment by anaesthetic nurses or anaesthesiologists to test its feasibility and pitfalls for ongoing utilisation during the COVID-19 pandemic.
Objectives :
A pilot program is set up to test the workflow for pre-anaesthetic teleconsultation, including patient selection, use of telecommunication devices for consultation, patient education, hardware and software (ZOOM) set up. The program also aims to assess patient’s satisfaction on use of teleconsultation and any inferiority of teleconsultation for quality of pre-anaesthetic assessment and patient safety compared to face-to-face pre-anaesthetic consultation.
Methodology :
A taskforce of telemedicine for pre-anaesthetic assessment and service in our department was formed in April 2020. The workgroup members for the pre-anaesthetic assessment service include anaesthesiologists and pre-anaesthetic assessment clinic nurses. The members discussed workflow, including case selection criteria and logistics for enrolment. In particular, special consideration was made to ensure the service complied with the Ethical Guidelines on Practice of Telemedicine issued by the Medical Council of Hong Kong, which address the quality of medical assessment and records, privacy, and patient confidentiality. 1,2 Personnel from the Information and Technology (IT) Department responsible for establishment of telecare service platforms in Kowloon East Cluster of Hospital Authority, had provided technical advices and support on software, hardware and connectivity for ensuring pre-anaesthetic assessment could be performed through teleconsultation. Zoom was the official application approved by the Hospital Authority to provide video-consultation services in Hong Kong. Anaesthesiologists or anaesthetic nurses performed screening for eligible patients via Electronic Patient Record (ePR). Eligible patients were invited to enrol the program via phone call. Once verbal consent for the teleconsultation program is obtained, essential information and instruction on use of ZOOM, link to the Teleconsultation webpage of information and consent, was sent to patients via email. Pre-anaesthetic assessment was performed via ZOOM. Upon completion of assessment, information on anaesthetic plan was explained to the patient. Verbal consent for the anaesthetic plan was obtained. Information for pre-operative preparation including fasting time, medication management and preparation for hospitalisation after surgery was explained by nurse. On day of surgery, the attending anaesthesiologist would review patient’s condition and complete the written anaesthetic consent before proceeding to anaesthesia.
Result & Outcome :
From May to September 2020, 10 patients had been enrolled to the pilot program with pre-anaesthetic assessment using teleconsultation. After the pilot program, 2 patients were invited and consented to use teleconsultation as an alternative to face-to-face pre-anaesthetic assessment. Teleconsultation for pre-anaesthetic assessment were successfully completed in 12-25min. 5 patients proceeded to surgery by the end of December 2020. 7 patients had their surgery further postponed due to service reorganisation with repeated surge of COVID-epidemic locally. The patients who had surgery during the pilot program completed the post-teleconsultation questionnaire. From the result of the post-teleconsultation service questionnaire, all of the 5 patients were satisfied with the process from enrolment, registration to commencement of the actual teleconsultation. They were also satisfied with the visual-audio quality of the teleconsultation. They agreed that the pre anaesthetic teleconsultation helped them to enhance their understanding of preoperative preparation for anaesthesia and surgery. The patients strongly agreed that pre-anaesthetic consultation using telecare could save time for travel to hospital. They would all agree to use teleconsultation for pre-anaesthetic assessment in the future if appropriate. The attending anaesthesiologists for the 5 patients did not report any abnormal conditions that were missed during the teleconsultation.
