Pre-anesthetic assessment clinics in Ontario

Abstract

Purpose: To survey the provision of pre-anesthetic assessment clinics in hospitals in Ontario during the summer of 1997. Methods: Mail survey questionnaire of all 300 hospitals in Ontario. Results: Replies were received from 260 hospitals (86.7%) of which 131 provide anesthesia. Of these, 86% are community and 14% teaching hospitals. Regular clinics are held in 63% of these hospitals, most commonly daily. As to location, 73% are held in the outpatient department. Written guidelines detailing which patients should be referred are issued by 77% of departments. The attending surgeon is the most common source of referral (64%). Referred patients are most commonly seen by a nurse (52%) who decides on onward referral to an anesthesiologist. Services generating the most referrals are general surgery (83%), orthopedics (64%) and obstetrics/gynecology (49%). In 47% of hospitals 10-50 patients are seen per month and they travel most commonly up to 100 km. The average 'no show' rate is 6.2%. Only 36% of departments assess patients the same day as seen by the surgeon. On attending the clinic, 51% can see an internist the same day in contrast to 30% being able to see a cardiologist. Pre-admission testing is available to 97% on the same day. Direct funding is available for the nurse (87%), physician (1%) and secretarial help (43%). Remuneration of the anesthesiologist is fee for service (99%) and sessional (1%). Conclusion: Pre-anesthetic assessment clinics are common in Ontario. More development is required to enable patients to receive all aspects of their preoperative assessment during one visit.