Back to Blog

Peri-intervention

“To anesthetize, or not to anesthetize?” - that is the question

The healthcare system must find smarter ways to allocate high-value tasks to professionals. In this article, we explore how to optimize pre-anesthesia assessments, guided by the latest updated recommendations from the European Society of Anaesthesiology and Intensive Care.

Diogo Machado

December 6, 2024 · 4 min read

The imbalance affecting today’s healthcare systems is well known: population needs are growing exponentially, while the capacity to respond remains linear. In this context of limited resources - and with an ever-increasing number of strong clinical guidelines - there’s a pressing need to allocate higher-value tasks more intelligently to healthcare professionals. As such, discussions about the potential of technology for a healthier, more efficient, and more advanced future are only meaningful if the foundation of care delivery is also transformed, freeing doctors, nurses, and other professionals to focus on high-value, high-impact tasks.
In this article, we specifically focus on optimizing pre-anesthesia assessments. To address the core question, we explore which lower-value tasks can be streamlined or automated.

The problem: inadequate preoperative workup is leading to surgery cancellations but there isn’t a standardized approach to doing it

Up to 25% of days of surgery cancellations are due to inadequate preoperative workup1, and it is well established that preoperative clinics reduce the risk of such cancellations and delays. However, there isn’t a standardized approach to do it.
Likewise, there is currently no standard protocol for determining which patients have Pre-Anesthetic Medical Evaluations (PAMEs),2 as the decision often varies depending on the surgical provider. In some practices, only high-risk patients are referred for a PAME, while others require all patients to complete one. For young, healthy, asymptomatic individuals, these evaluations rarely result in changes to medication or the need for pre-operative testing. Evidence suggests routine laboratory screening tests seldom influence surgical management or improve clinical outcomes. Furthermore, the anesthesia team often conducts its preanaesthetic assessment before surgery, which can lead to duplicate evaluations.
Recently, the COVID-19 pandemic compelled the healthcare system to adopt new practices and expedite the implementation of others that had been progressing gradually. In 2020, this led to the release of the Guidelines: Anesthesia in the Context of the COVID-19 Pandemic,3 where experts recommended using a standardized questionnaire to screen for symptoms of SARS-CoV-2 infection before any surgery. If this approach was effective during the pandemic, why not apply it universally to all surgeries?

The power of a questionnaire

Using a standardized questionnaire enhances the thoroughness of symptom collection and ensures the reproducibility of medical examinations. It is an effective tool for gathering accurate information from many patients. The collected data are easily quantifiable and traceable. For such a questionnaire to be effective, it must possess key qualities like acceptability, reliability, and validity. The questions should be formulated to be easily understood by the widest range of patients, free of ambiguity, and based on evidence-validated items.

What’s new? Strong recommendation to use telemedicine and standardized questionnaires on the preoperative anesthesia assessment.

A new guideline from the European Society of Anaesthesiology and Intensive Care, published a few weeks ago in the European Journal of Anaesthesiology, recommends:

“Using telemedicine and standardized questionnaires as part of the preoperative anesthesia assessment to improve patient access to care and increase their satisfaction.” 4

This is a strong recommendation (1B), meaning it should be followed in most cases, as there is a high level of confidence that the benefits outweigh the risks.
According to the authors, various telemedicine applications have been reported to significantly boost scientific output during the COVID-19 pandemic. Although it doesn't allow for a physical examination, telemedicine enables the collection of information before a patient's admission, helping with the screening and triaging of those with suspected or confirmed infections, as well as assessing the severity and progression of their condition. Additionally, telemedicine can help identify patients who need an in-person preoperative evaluation due to multiple comorbidities.

UpHill’s Perioperative Package: reducing surgical wait times, preventing cancellations, and ensuring a safe return home

UpHill is a care orchestration software that seamlessly integrates with existing hospital information systems to automate tasks and fill gaps in care. Our Perioperative Package is designed to achieve the following goals:
  • Reduce surgical wait times
  • Prevent cancellations and readmissions
  • Improve clinical teams’ efficiency
  • Promote a safe return to an active life
To achieve this, we focus on three key areas:
  1. Reducing pre-surgery medical interactions, to ease the burden on anesthesiology teams.
  2. Automating the calculating of anesthetic risk, allowing attention to be focused on high-risk patients, and creating a “fast track” for the low-risk patients.
  3. Optimizing and standardizing follow-up processes, to lessen the workload for nursing teams and reduce the risk of readmissions after discharge.

A future (closer than it seems) where technology frees healthcare teams from low-value tasks

UpHill is thrilled to see these guidelines published, as they perfectly align with the vision our medical team has for optimizing the perioperative process, which is already being implemented in several healthcare institutions.
By using scientifically validated questionnaires and scores to stratify patients based on their surgical and individual risks, we ensure that everyone receives a pre-anesthesia assessment. At the same time, healthcare teams can focus their valuable time on higher-risk patients. This approach clearly separates low-value tasks from high-value ones, leading to more efficient and sustainable healthcare systems.
From the patient’s perspective, the benefits are significant. Patients can provide information about their condition at a time and place that suits them. This inclusive approach ensures that everyone is assessed, while also eliminating unnecessary in-person appointments, reducing wait times, and allowing healthcare professionals to focus more on complex cases.
 So, to answer the original question: yes, anesthetize safely.

References

  1. Knox, M., Myers, E., & Hurley, M. (2009). The impact of pre-operative assessment clinics on elective surgical case cancellations. The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 7(2), 76–78. https://doi.org/10.1016/s1479-666x(09)80019-x
  2. Khera, K. D., Blessman, J. D., Deyo-Svendsen, M. E., Miller, N. E., & Angstman, K. B. (2022). Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits. Health services research and managerial epidemiology, 9, 23333928221074895. https://doi.org/10.1177/23333928221074895
  3. Velly, L., Gayat, E., Quintard, H., Weiss, E., De Jong, A., Cuvillon, P., Audibert, G., Amour, J., Beaussier, M., Biais, M., Bloc, S., Bonnet, M. P., Bouzat, P., Brezac, G., Dahyot-Fizelier, C., Dahmani, S., de Queiroz, M., Di Maria, S., Ecoffey, C., Futier, E., … Garnier, M. (2020). Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesthesia, critical care & pain medicine, 39(3), 395–415. https://doi.org/10.1016/j.accpm.2020.05.012
  4. Lamperti, M., Romero, C. S., Guarracino, F., Cammarota, G., Vetrugno, L., Tufegdzic, B., Lozsan, F., Macias Frias, J. J., Duma, A., Bock, M., Ruetzler, K., Mulero, S., Reuter, D. A., La Via, L., Rauch, S., Sorbello, M., & Afshari, A. (2025). Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology, 42(1), 1–35. https://doi.org/10.1097/EJA.0000000000002069

Diogo Machado

Medical Advisor

Senior Anesthesiologist with proficiency in Acute and Chronic Pain. Emergency Physician and Flight Doctor. Passionate about AI, Data Science and Programming.

Get the latest on UpHill resources.