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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2010 Luglio;76(7):491-9
The Anesthesia Preoperative Evaluation Clinic (APEC): a prospective randomized controlled trial assessing impact on consultation time, direct costs, patient education and satisfaction with anesthesia care
Schiff J. H., Frankenhauser S., Pritsch M., Fornaschon S. A., Snyder-Ramos S. A., Heal C., Schmidt K., Martin E., Böttiger B. W., Motsch J. ✉
1 Department of Anesthesiology, University Hospital, Heidelberg, Germany;
2 James Cook University, Townsville Campus, Department of Anesthetics, Mackay Base Hospital Queenland, Australia;
3 Department of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany;
4 Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
AIM: Anesthetic preoperative evaluation clinics (APECs) are relatively new institutions. Although cost effective, APECs have not been universally adopted in Europe. The aim of this study was to compare preoperative anesthetic assessment in wards with an APEC, assessing time, information gain, patient satisfaction and secondary costs.
METHODS: Two hundred and seven inpatients were randomized to be assessed at the APEC or on the ward by the same two senior anesthetists. The outcomes measured were the length of time for each consultation, the amount of information passed on to patients and the level of patient satisfaction. The consultation time was used to calculate impact on direct costs. A multivariate analysis was conducted to detect confounding variables.
RESULTS: Ninety-four patients were seen in the APEC, and 78 were seen on the ward. The total time for the consultation was shorter for the APEC (mean 8.4 minutes [P<0.01]), and we calculated savings of 6.4 € per patient. More information was passed on to the patients seen in the APEC (P<0.01). The general satisfaction scores were comparable between groups. A multivariate analysis found that the consultation time was significantly influenced by the type of anesthesia, the magnitude of the operation and the location of the consultation. Gain in information was significantly influenced by age, education and the location of the visit.
CONCLUSION: The APEC reduced consultation times and costs and had a positive impact on patient education. The cost savings are related to personnel costs and, therefore, are independent of other potential savings of an APEC, whereas global patient satisfaction remains unaltered.