Background: Novant Health is a leading healthcare provider in North Carolina, with 15 hospitals and 14 ambulatory surgery centers across the state. In the preoperative assessment arena, there are currently ten pre-admission testing clinics that are staffed by either hospitalists, anesthesia providers, or both. Variable preoperative assessment criteria exist for each surgical location, with no standard triage or risk stratification process being utilized to determine a patient’s required level of preoperative evaluation (phone call, nurse visit, or provider visit).
Purpose: With the collaboration of anesthesia and hospitalist leaders across the geographic markets, we set out to design a single preoperative medical questionnaire for use throughout Novant Health as an initial step in building a Perioperative Surgical Home. The preoperative medical questionnaire engages patients in their perioperative care through use of MyChart, reduces variability in preoperative assessment across markets and surgical locations, and Improves efficiency in pertinent history gathering in advance of the preoperative assessment. This helps to ensure that all patients, regardless of location, receive the appropriate level of evaluation prior to surgery.
Description: Four anesthesiologists and four hospitalists reviewed perioperative literature related to preoperative triage tools. Existing screening tools across Novant Health were then analyzed for comparison, and the key elements of a preoperative screening questionnaire were identified. After completing a review of language and content by the Novant Health Literacy team, a MyChart questionnaire was built, with weights assigned in the background to each question or their cascading components. The cumulative weights of the questionnaire then generate a medical complexity score for the patient, further aiding in preoperative triage. The MyChart Pre-Surgical Questionnaire went live with surgical case postings across Novant markets in June 2022, replacing all pre-existing questionnaire documents.
Conclusions: Novant Health’s development of a universal preoperative medical questionnaire encourages patient participation and patient-centered care through use of MyChart. The perioperative team is able to gather pertinent history from the patient the moment that a surgical case is posted, enabling early risk stratification and appropriate triage for preoperative evaluation. Furthermore, the creation of a medical complexity score from the questionnaire, and the score’s visibility in various phases of perioperative care, allows a perioperative provider to quickly assess medical complexity on the anesthesia board or in the electronic medical record.
