VAV – Virtual Anaesthesia Visit - An online tool for the preanaesthesia visit in the CHVR (Centre hospitalier du Valais Romand)

Abstract

INTRODUCTION: Safety is an important issue in anesthesia. Preoperative risk managing strategies include the designation of an ASA score and a preanesthesia visit (PAV) in order to reduce anesthesia and surgery related risk. Logistical, geographical and linguistic difficulties can be obstacles to a PAV. Computer based assessment and patient video-information to overcome some of these obstacles have been investigated. The aim of the present project was to develop an electronic alternative to the conventional PAV visit in the CHVR. METHODS: After a preliminary study based on data extracted from the Clinical Information System to delimit the target population, a group composed of senior anesthetists, a trainee anesthetist, a photographer and a computer scientist created a new online preanaesthesia assessment tool. A feasibility test was conducted with a random sample of patients. RESULTS: The 2015 patient cohort study showed a median age of 57 years, with a predominant ASA 2 status . 23,6% of the patients reside in the German speaking Upper Valais. The maximal distance for a PAV was 103km. These results were the basis for the design of the electronic alternative called VAV, composed of 3 elements: 1) a selection tool of the surgical procedure linked to a surgical risk category, and one out of four information videos about the proposed anesthesia technique; 2) an electronic patient assessment questionnaire; 3) two algorithms: one concealing a computerized ASA score (cASA) and one assigning patients at risk for a standard visit. The data of the VAV will be imported in the patient’s CIS after completion and deleted on the server. VAV is intended to be used by any adult patient scheduled for non-cardiac surgery. The VAV includes a video dedicated to pregnant woman in order to inform them at distance from the delivery about the analgesic procedures and anesthesia techniques for surgical delivery procedures. CONCLUSION: The VAV was designed for the CHVR patient population. It is adapted with contemporary web-connectivity as it combines elements of patient assessment, patient information and informed consent in one single on-line tool. The aim of the VAV is to lead to a better assessment through a standardized tool, specially for vulnerable patients in order to triage them better, and increase safety