PreOp+

Reimagining the preoperative anesthesia evaluation process

Opportunity

More than 25,000 surgical procedures are scheduled annually at the Perelman Center for Advanced Medicine (PCAM) and the Hospital of the University of Pennsylvania (HUP) as elective day-of-surgery admissions or outpatient procedures.

Research shows that preoperative anesthesia evaluation decreases patient complications, morbidity, and mortality. When we started work in this area, approximately 99 percent of the patients scheduled for surgical procedures at PCAM and HUP did not discuss the details of their medical history with an anesthesiologist until the day of their scheduled surgery. New information elicited during such interviews was causing inefficiencies in care such as delays and cancellations.

In looking to peer institutions, we found that many health systems attempt to address this complex issue with costly, resource-intensive preoperative anesthesia clinics that require patients to attend an additional office-based evaluation before their procedure.

Intervention

PreOp+ is a screening program that shifts anesthesiologist involvement upstream to collect critical information weeks before a patient's surgery.

Patients are prompted to complete an evidence-based questionnaire administered on a tablet during patient admission testing (PAT) prior to surgery. The survey takes less than four minutes to complete and requires no clinical guidance. Results are pushed directly to the patient's medical record. 

Patients flagged as high-risk are automatically triaged to an existing anesthesia consultation service so that the dialogue between anesthesiologists and surgeons about how to best prepare for a successful surgery can begin immediately.

Impact

PreOp+ delivers the value of a preoperative anesthesia clinic without disrupting clinical workflow, burdening patients, or adding additional cost. The tool drives better health outcomes, decreases delays and cancellations on the day of surgery, reduces poor patient experience, and saves the health system money. 

PreOp+ has been in use at the PAT Center at PCAM since 2018.

Phase 3: How we work
Collaborators

Onyi Onuoha, MD, MPH
Marc Royo, MD, MBA
Lee Fleisher, MD

Innovation leads

Mike Serpa, MS
Roy Rosin, MBA

Funding

Innovation Accelerator Program

Innovation Methods

Quantitative data review
Gathering and analyzing quantitative data - the "what" is happening - can help inform your understanding of the problem space and enable you to establish benchmarks for evaluating solutions.
Quantitative data review
We conducted chart reviews to identify the drivers of non-inpatient day-of-surgery cancellations.
 
A five-month retrospective review demonstrated that 25 percent of day-of-surgery cancellations could be classified as potentially preventable. Drivers of cancellation or significant delay were unanticipated advanced cardiopulmonary disease, history of an implanted cardiac device, history of a difficult airway, and long-standing chronic pain.
 
We used this information to devise the first version of our preoperative screening survey.
Fake front end
Piloting a fake front end involves putting a simulated version of a product into the hands of intended users - one that doesn't yet actually perform the intended function - so that you can observe if and how it will be used in context.
 
A fake front end will help you answer the question, "What will people do with this?"
 
The first successful mobile device was created by an innovator who carried a block of wood around in his pocket to see when and why he pulled it out to pretend using it, revealing both what to build and how to build it.
Fake front end
Before securing tablets to deliver the preoperative screening survey, we deployed the survey on paper.
 
We collected feedback from providers and patients and adjusted the survey's content and phrasing to increase clarity with each iteration.
 
During the pilot phase, approximately one in ten patients triggered a high-risk alert and required intervention - validating that our tool could pinpoint issues before the day of surgery.

Videos

Pitch Day 2016