Development, Implementation, and Evaluation of a Telemedicine Preoperative Evaluation Initiative at a Major Academic Medical Center.

Abstract:

BACKGROUND:With health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. In this article, we describe the implementation of a telemedicine-based anesthesia preoperative evaluation and report the program's patient satisfaction, clinical case cancellation rate outcomes, and cost savings in a large metropolitan area (Los Angeles, CA). METHODS:This is a descriptive study of a telemedicine-based preoperative anesthesia evaluation process in an academic medical center within a large metropolitan area. In a 2-year period, we evaluated 419 patients scheduled for surgery by telemedicine and 1785 patients who were evaluated in-person. RESULTS:Day-of-surgery case cancellations were 2.95% and 3.23% in the telemedicine and the in-person cohort, respectively. Telemedicine patients avoided a median round trip driving distance of 63 miles (Q1 24; Q3 119) and a median time saved of 137 (Q1 95; Q3 195) and 130 (Q1 91; Q3 237) minutes during morning and afternoon traffic conditions, respectively. Patients experienced time-based savings, particularly from traveling across a metropolitan area, which amounted to $67 of direct and opportunity cost savings. From patient satisfaction surveys, 98% (129 patients out of 131 completed surveys) of patients who were consulted via telemedicine were satisfied with their experience. CONCLUSIONS:This study demonstrates the implementation of a telemedicine-based preoperative anesthesia evaluation from an academic medical center in a metropolitan area with high patient satisfaction, cost savings, and without increase in day-of-procedure case cancellations.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Kamdar NV,Huverserian A,Jalilian L,Thi W,Duval V,Beck L,Brooker L,Grogan T,Lin A,Cannesson M

doi

10.1213/ANE.0000000000005208

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

1647-1656

issue

6

eissn

0003-2999

issn

1526-7598

pii

00000539-202012000-00001

journal_volume

131

pub_type

杂志文章
  • Immobilizing doses of halothane, isoflurane or propofol, do not preferentially depress noxious heat-evoked responses of rat lumbar dorsal horn neurons with ascending projections.

    abstract:BACKGROUND:The spinal cord is an important site where volatile anesthetics decrease sensation and produce immobility. Beyond this knowledge, our understanding of a site of anesthetic action is limited. Previous evidence suggests that dorsal horn neurons with ascending projections may be more susceptible to depression b...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ane.0b013e318163f8f3

    authors: Barter LS,Mark LO,Jinks SL,Carstens EE,Antognini JF

    更新日期:2008-03-01 00:00:00

  • Informed Consent in Pediatric Anesthesia: A Narrative Review.

    abstract::Informed consent for pediatric anesthesia challenges practitioners to navigate complex ethical, medical, and legal ambiguities. A patient's status as a minor does not negate the importance of his or her participation in the decision-making process but, rather, necessitates a nuanced evaluation of age and development t...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0000000000003705

    authors: Feinstein MM,Pannunzio AE,Lobell S,Kodish E

    更新日期:2018-12-01 00:00:00

  • Dopamine D3 receptor Ser9Gly and catechol-o-methyltransferase Val158Met polymorphisms and acute pain in sickle cell disease.

    abstract:BACKGROUND:Pain in sickle cell disease (SCD) is characterized by episodes of acute pain, primarily responsible for acute health care utilization, and persistent chronic pain. Pain severity and frequency vary significantly among patients with SCD. In this study, we investigated the possible contribution of monoamine gen...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000000382

    authors: Jhun E,He Y,Yao Y,Molokie RE,Wilkie DJ,Wang ZJ

    更新日期:2014-11-01 00:00:00

  • GABA(A) receptor blockade antagonizes the immobilizing action of propofol but not ketamine or isoflurane in a dose-related manner.

    abstract:UNLABELLED:The enhancing action of propofol on gamma-amino-n-butyric acid subtype A (GABA(A)) receptors purportedly underlies its anesthetic effects. However, a recent study found that a GABA(A) antagonist did not alter the capacity of propofol to depress the righting reflex. We examined whether the noncompetitive GABA...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ane.0000048821.23225.3a

    authors: Sonner JM,Zhang Y,Stabernack C,Abaigar W,Xing Y,Laster MJ

    更新日期:2003-03-01 00:00:00

  • Levobupivacaine-sufentanil with or without epinephrine during epidural labor analgesia.

    abstract::In a prospective, randomized, double-blind study, we investigated whether epinephrine increased the efficacy of levobupivacaine and sufentanil during epidural labor analgesia. Seventy term parturients received an epidural injection of levobupivacaine 0.125% and sufentanil 0.75 microg/mL with or without 1:800,000 epine...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1213/01.ane.0000221038.46094.c0

    authors: Soetens FM,Soetens MA,Vercauteren MP

    更新日期:2006-07-01 00:00:00

  • Immunoreactive substance P is decreased in saliva of patients with chronic back pain syndromes.

    abstract::Substance P, a neuropeptide associated with pain perception, is widely distributed in the central nervous system and is decreased in the cerebrospinal fluid of chronic pain patients as compared with that of healthy human volunteers. In this study, we have demonstrated the presence of immunoreactive substance P in sali...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-199001000-00010

    authors: Parris WC,Kambam JR,Naukam RJ,Rama Sastry BV

    更新日期:1990-01-01 00:00:00

  • Dolasetron for preventing postanesthetic shivering.

    abstract:UNLABELLED:We designed this study to assess the efficacy of dolasetron compared with clonidine and placebo in prophylaxis of postanesthetic shivering. We included 90 patients undergoing elective abdominal or urologic surgery. The patients were randomly assigned to one three groups (each group n = 30) using a double-bli...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验,收录出版

    doi:10.1097/00000539-200201000-00020

    authors: Piper SN,Röhm KD,Maleck WH,Fent MT,Suttner SW,Boldt J

    更新日期:2002-01-01 00:00:00

  • The effects of ketamine on the temporal summation (wind-up) of the R(III) nociceptive flexion reflex and pain in humans.

    abstract:UNLABELLED:Animal studies have suggested that the temporal summation of nociceptive inputs might play a significant role in the development of central sensitization (i.e., hyperexcitability of central nociceptive neurons) and hyperalgesia via the activation of N-methyl-D-aspartate receptors. To further analyze these pr...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000539-200002000-00031

    authors: Guirimand F,Dupont X,Brasseur L,Chauvin M,Bouhassira D

    更新日期:2000-02-01 00:00:00

  • Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up.

    abstract:BACKGROUND:Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000001308

    authors: Cyriac J,Garson L,Schwarzkopf R,Ahn K,Rinehart J,Vakharia S,Cannesson M,Kain Z

    更新日期:2016-07-01 00:00:00

  • The analgesic effect of tramadol after intravenous injection in healthy volunteers in relation to CYP2D6.

    abstract::Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/01.ane.0000189613.61910.32

    authors: Enggaard TP,Poulsen L,Arendt-Nielsen L,Brøsen K,Ossig J,Sindrup SH

    更新日期:2006-01-01 00:00:00

  • Generative Retrieval Improves Learning and Retention of Cardiac Anatomy Using Transesophageal Echocardiography.

    abstract:BACKGROUND:Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in th...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/ANE.0000000000002004

    authors: Kleiman AM,Forkin KT,Bechtel AJ,Collins SR,Ma JZ,Nemergut EC,Huffmyer JL

    更新日期:2017-05-01 00:00:00

  • American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

    abstract::Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. The...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0000000000002758

    authors: Abola RE,Bennett-Guerrero E,Kent ML,Feldman LS,Fiore JF Jr,Shaw AD,Thacker JKM,Gan TJ,Miller TE,Hedrick TL,McEvoy MD,Mythen MG,Bergamaschi R,Gupta R,Holubar SD,Senagore AJ,Wischmeyer PE,Carli F,Evans DC,Guilbert S,

    更新日期:2018-06-01 00:00:00

  • The care of patients with phantom limb pain in a pain clinic.

    abstract::Patients referred to the Pain Clinic at the University of Virginia Medical Center with genuine phantom pain rather than stump pain have been treated by a variety of technics. Simple revision of drug therapy has proved helpful in some instances, as has repeated injection of trigger areas or neuromata, though surgical e...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-197711000-00019

    authors: Blankenbaker WL

    更新日期:1977-11-01 00:00:00

  • Hemodynamic responses to physostigmine in patients with a drug overdose.

    abstract::Hemodynamic responses to physostigmine were evaluated in eight patients with coma due to overdose with mainly anticholinergic drugs (AC) and in five patients with coma due to overdose with nonanticholinergic drugs (NAC). After correction of hypovolemia, but before administration of physostigmine, AC patients had signi...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:

    authors: Nilsson E,Meretoja OA,Neuvonen P

    更新日期:1983-10-01 00:00:00

  • Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    abstract:BACKGROUND:Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pu...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0b013e3181b278a3

    authors: McCaul C,Kornecki A,Engelberts D,McNamara P,Kavanagh BP

    更新日期:2009-10-01 00:00:00

  • Assessment of Tricuspid Annular Motion by Speckle Tracking in Anesthetized Patients Using Transesophageal Echocardiography.

    abstract:BACKGROUND:The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transes...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000002614

    authors: Shen T,Picard MH,Hua L,Burns SM,Andrawes MN

    更新日期:2018-01-01 00:00:00

  • Effect of cardiopulmonary bypass on plasma levels of nifedipine.

    abstract::Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nifedipine is often used to provide protection from coronary ischemia, a determination of the effect of CPB on plasma nifedipine levels might help to determine the potential clinical benefit of nifedipine during and after byp...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章

    doi:10.1213/00000539-199010000-00016

    authors: Katz RI,Kanchuger MS,Patton KF,Eide TR

    更新日期:1990-10-01 00:00:00

  • The anesthetic mechanism of urethane: the effects on neurotransmitter-gated ion channels.

    abstract:UNLABELLED:Urethane is widely used as an anesthetic for animal studies because of its minimal effects on cardiovascular and respiratory systems and maintenance of spinal reflexes. Despite its usefulness in animal research, there are no reports concerning its molecular actions. We designed this study to determine whethe...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1097/00000539-200202000-00015

    authors: Hara K,Harris RA

    更新日期:2002-02-01 00:00:00

  • Prevention of atelectasis formation during induction of general anesthesia.

    abstract:UNLABELLED:General anesthesia promotes atelectasis formation, which is augmented by administration of large oxygen concentrations. We studied the efficacy of positive end-expiratory pressure (PEEP) application during the induction of general anesthesia (fraction of inspired oxygen [FIO(2)] 1.0) to prevent atelectasis. ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ane.0000087042.02266.f6

    authors: Rusca M,Proietti S,Schnyder P,Frascarolo P,Hedenstierna G,Spahn DR,Magnusson L

    更新日期:2003-12-01 00:00:00

  • Transient atrioventricular block after release of aortic cross-clamp.

    abstract::To determine the incidence of atrioventricular (A-V) block, 86 patients, aged 58.9 +/- 10.4 yr, undergoing elective coronary artery bypass grafting (CABG) during aortic cross-clamping (ACC) and cold potassium cardioplegia were investigated. The incidence and duration of complete A-V block after release of the aortic c...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1097/00000539-199501000-00009

    authors: Baraka AS,Taha SK,Yazbeck VK,Rizkallah PA,Zughbi JP,Aouad MJ,Rouhana CS,Nader AM

    更新日期:1995-01-01 00:00:00

  • The effect of celiac plexus block in critically ill patients intolerant of enteral nutrition: a randomized, placebo-controlled study.

    abstract:BACKGROUND:In this study, we evaluated the efficacy of celiac plexus block for the treatment of feeding intolerance in critically ill patients. METHODS:Nineteen mechanically ventilated medical patients intolerant of enteral nutrition and receiving metoclopramide underwent bilateral celiac plexus block. The anterior pr...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验,收录出版

    doi:10.1213/ANE.0b013e3181cde870

    authors: Memis D,Inal MT,Temizoz O,Genchallac H,Ozdemir H,Sut N

    更新日期:2010-04-01 00:00:00

  • Increasing halothane concentrations reduce nitroprusside dose requirement.

    abstract::There has been no description of the hemodynamic dose-response relationship between halothane and sodium nitroprusside (SNP), although these drugs are used together frequently for induction of deliberate hypotension. Utilizing aortic root cannulation and thermister-tipped pulmonary artery catheterization, this relatio...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-197807000-00016

    authors: Bedford RF

    更新日期:1978-07-01 00:00:00

  • Postoperative intravenous morphine consumption, pain scores, and side effects with perioperative oral controlled-release oxycodone after lumbar discectomy.

    abstract:BACKGROUND:Oral opioid formulations contribute to postoperative analgesia. In this study, we evaluated the perioperative application of oral controlled-release oxycodone to reduce postoperative IV morphine consumption and opioid side effects after lumbar discectomy. METHODS:Forty patients scheduled for elective lumbar...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/01.ane.0000266451.77524.0d

    authors: Blumenthal S,Min K,Marquardt M,Borgeat A

    更新日期:2007-07-01 00:00:00

  • Postoperative Critical Events Associated With Obstructive Sleep Apnea: Results From the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry.

    abstract:BACKGROUND:Obstructive sleep apnea (OSA) patients are at increased risk for pulmonary and cardiovascular complications; perioperative mortality risk is unclear. This report analyzes cases submitted to the OSA Death and Near Miss Registry, focusing on factors associated with poor outcomes after an OSA-related event. We ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000005005

    authors: Bolden N,Posner KL,Domino KB,Auckley D,Benumof JL,Herway ST,Hillman D,Mincer SL,Overdyk F,Samuels DJ,Warner LL,Weingarten TN,Chung F

    更新日期:2020-10-01 00:00:00

  • Recovery of the swallowing reflex after propofol anesthesia.

    abstract::The swallowing reflex is depressed by anesthetics. During recovery from anesthesia the rapid return of laryngeal and upper airway reflexes is important to protect the lower airway from aspiration. This study measures the recovery of the swallowing reflex after propofol anesthesia. Fifteen patients undergoing a colonos...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-199411000-00007

    authors: Rimaniol JM,D'Honneur G,Duvaldestin P

    更新日期:1994-11-01 00:00:00

  • The current status of continuous noninvasive measurement of total, carboxy, and methemoglobin concentration.

    abstract::Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. The sam...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0b013e318233041a

    authors: Shamir MY,Avramovich A,Smaka T

    更新日期:2012-05-01 00:00:00

  • Enflurane, halothane, and isoflurane inhibit removal of 5-hydroxytryptamine from the pulmonary circulation.

    abstract::We were interested in determining the effect of enflurane, halothane, and isoflurane on the uptake and removal of 5-hydroxytryptamine (5-HT) and phenylethylamine (PEA) from the lung. Isolated rabbit lungs were perfused in a recirculating system in vitro with 0.1 microM [14C]5-HT or 0.1 microM [14C]PEA in Krebs-Ringer ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:

    authors: Cook DR,Brandom BW

    更新日期:1982-08-01 00:00:00

  • Propofol versus propofol-ketamine sedation for retrobulbar nerve block: comparison of sedation quality, intraocular pressure changes, and recovery profiles.

    abstract:UNLABELLED:We compared sedation quality, intraocular pressure (IOP) changes, and recovery profiles in patients who received propofol or propofol-ketamine sedation during placement of the retrobulbar nerve block (RBB). Seventy elderly patients undergoing cataract extraction according to a prospective, randomized, double...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000539-199908000-00013

    authors: Frey K,Sukhani R,Pawlowski J,Pappas AL,Mikat-Stevens M,Slogoff S

    更新日期:1999-08-01 00:00:00

  • Protamine reversal of heparin affects platelet aggregation and activated clotting time after cardiopulmonary bypass.

    abstract:UNLABELLED:Bleeding after cardiopulmonary bypass (CPB) is related to multiple factors. Excess protamine weakens clot structure and decreases platelet function; therefore, an increased activated clotting time (ACT) after protamine reversal of heparin may be misinterpreted as residual heparin anticoagulation. We evaluate...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1097/00000539-199810000-00008

    authors: Mochizuki T,Olson PJ,Szlam F,Ramsay JG,Levy JH

    更新日期:1998-10-01 00:00:00

  • Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies.

    abstract::The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesi...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0b013e31826918b6

    authors: Meyer MJ,Krane EJ,Goldschneider KR,Klein NJ

    更新日期:2012-12-01 00:00:00