North York General Hospital’s (NYGH) Preoperative Assessment Clinic (PAC) was evaluating about 40 patients per day and over 900 patients per year. Most of these patients were presenting for low/moderate-risk surgery and were considered low/moderate-risk patients. An internal audit revealed that many of these cases underwent pre-surgical assessments and investigations that were deemed to be medically unnecessary because they did not provide useful information that subsequently altered perioperative patient care or outcomes. In fact, many of these preoperative clinic visits and test may contribute to healthcare system ine ciency/cost, potential patient harm due to medical intervention and follow-up and wastage of patients’ time and opportunity cost. As a result, a multidisciplinary team was formed to re-evaluate the medical priorities of the PAC and create a system that provided individual, patient-focused care designed to avoid medically-unnecessary pre-operative assessments and investigations. The PAC at NYGH was able to achieve a sustained 30-40% reduction in both preoperative assessments and investigations without any documented/perceived negative outcomes in patient care.
The Drop the Pre-Op toolkit contains the key ingredients of their approach.