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.

Figure 1.

UCLA Health PEPC Screening Process for evaluation of preoperative patients suitable for a telemedicine visit. Dotted arrows indicate possible flow if clinical decision is made. PEPC indicates preoperative evaluation and planning center; UCLA, University of California, Los Angeles.

Figure 2.

IT infrastructure. A, The computer console with the provider and video camera (left) on the upper panel of the computer monitor (right). B, Epic display that shows when the patient is active and ready for a telemedicine visit and is waiting for their provider to log into the encounter. The provider can connect either via the desktop computer monitor or from their mobile smartphone. C, The telemedicine encounter utilizes a window to display the patient with a smaller image to show the provider(s). D, The display from Epic smartphone mobile app so that patients can identify their video visit time and provider. E, The smartphone video encounter utilizes the phone’s cameras to display both patient and provider on the single screen. The patient can obtain the after-visit recommendations within their phone directly from their anesthesia provider. ^©Epic Systems Corporation. Used with permission.

Figure 3.

Geographical distribution of patients who had a UCLA Health PEPC telemedicine encounter. PEPC indicates preoperative evaluation and planning center; UCLA, University of California, Los Angeles.

Figure 4.

Savings vignette from a hypothetical patient to show readers how to navigate the sensitivity analyses presented in Table 3. UCLA indicates University of California, Los Angeles.