The Preanaesthesia Period: Preoperative Anaesthesia Clinic

Introduction

Value in health care has been described as quality divided by cost, where quality is the sum of patient outcomes and experience. A well-run preoperative anaesthesia clinic (PAC) offers many opportunities to improve the value of the care delivered to patients by reducing the associated costs and improving the quality of care, i.e., reduction in excessive preoperative testing, reduction in subspecialty consults, delay in surgery and others. Innovative ways of preoperative evaluation methods include questionnaires, telephonic interviews, automated interviews, and computerised interviews and interviews via virtual platforms such as Zoom or Skype.

The gold standard is still face-to-face evaluation.

1. Location of PAC
   • It should be easily accessible
   • Preferably in the same hospital complex as where surgery is done
   • It should have easy access to diagnostic and other support services
2. Physical design of PAC
   • Reception and registration area
   • Patient interview and examination area
3. Staffing requirements of PAC
   • Administrative staff
   • Registered sister
4. Appointments to PAC
   • Usually 2–30 days before surgery
   • Importantly, it should not be on the same day as surgery
5. Referring and feedback system to subspecialties
6. Data collection and recording of PAC
   • Computer database
7. Equipment
   • Basic vital signs:
     • BP, ECG, SpO₂
   • Other equipment depends on comorbidities and availability:
     • Respiratory function tests – flow loops
     • Heart – transthoracic echocardiography (TTE)
     • Chest X-ray (CXR), bloods
     • Other equipment as may be deemed necessary If this does not form part of the clinic equipment itself, it should be available as near as possible to the PAC.

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South African Society of Anaesthesiologists (SASA) Practice Guidelines_2022_Reviewed by: P Bettings