Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures

Objective

To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.

Patients and Methods

Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ², Fisher exact, or Mann-Whitney U tests.

Results

Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.

Conclusion

These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.