A useful mnemonic for pre-anesthetic assessment

Effect of patient information leaflet on working pattern and patient satisfaction level in a busy Indian day care operative theater complex

Background and Aims:

In a day care setting, communication of preprocedure instructions prior to general anesthesia (GA) is critical. Verbal information may be inadequate at times leading to unnecessary rescheduling. The aim of the study is to evaluate the use of patient information leaflet (PIL) and its impact on rescheduling and patients’ satisfaction levels.

Material and Methods:

Adult ASA I-III patients scheduled for elective day care Head Neck procedures such as direct laryngoscopy, examination under anesthesia, and biopsy under GA were recruited. In the outpatient department (OPD), the attending surgeons verbally instructed the patients as well as handed them the PIL. The process was streamlined over a month and thereafter patients’ satisfaction levels and rescheduling rates were captured over 2 months. This was compared to the data from the pre-PIL phase.

Result:

Prior to PIL, 12% cases were rescheduled due to avoidable causes. After introducing of the PIL, only 8% case were rescheduled (P = 0.02). There was a significant improvement seen in patient satisfaction with 89% patients reporting that the PIL was good or better while 77% were willing to recommend it to the others.

Conclusion:

PIL is an effective way of imparting perioperative instructions to patients which will improve not only satisfaction but also reduce patient rescheduling. The institution is in the process of implementing PIL to provide instructions to patient posted for day care procedures.

Preanaesthetic assessment and management in the context of the district hospital

Preanaesthetic assessment and management allow for the systematic identification of perioperative risks and the implementation of interventions to mitigate them, such that the patient's physiological state is optimised for surgery or other procedures. This is a crucial activity for good perioperative outcomes, as patients not assessed are at a higher risk of unanticipated adverse perioperative events and are more likely to receive suboptimal management. The district hospitals in South Africa perform minor and moderately complex surgical procedures that require anaesthesia, administered mostly to healthy patients and those with stable diseases without functional limitations. A significant proportion of anaesthesia-related deaths reported in the district hospitals can be linked to poor risk assessment and management. In this article, we highlight the key clinical imperatives for optimal preanaesthetic assessment and management from the district hospital perspective.

Preparation, validation, and evaluation of an information leaflet for patients undergoing day-care surgeries under general anesthesia at a busy tertiary care hospital

Background and Aims:

It is essential that patients posted for day-care surgeries are adequately prepared preoperatively. Verbal information alone may not be always effective. This study aimed to prepare, validate, and evaluate the efficacy of a patient information leaflet (PIL) for patients undergoing day-care surgeries under general anesthesia (GA).

Material and Methods:

After approval from the hospital ethics committee a PIL was prepared in English. Readability and design of the leaflet were checked using standard tests: Flesch readability ease test (FRE), Flesch Kincaid grade level (FKGL), and Baker Able leaflet design (BALD). It was translated into three regional languages. The PIL was tested among patients using a questionnaire. Seventy-nine adult patients posted for elective day-care procedures were included while emergency surgeries were excluded. Patient knowledge pre and post-PIL was compared using paired 't' test. The influence of age, gender, and education level on the usefulness of PIL were analyzed using the Chi-square test and knowledge was compared using ANOVA.

Results:

The English leaflet had an FRE Score of 63.9 and FKGL of 6.4, which is “standard“. The BALD score for all leaflets was 25 (“above standard“). The overall knowledge scores significantly improved from 52.6% (preintervention) to 70.7% (postintervention), P < 0.001. Knowledge improvement was seen with the use of PIL in all four languages. Sixty eight percent of patients strongly recommended the PIL while 31% were willing to recommend it to others.

Conclusion:

The PILs developed in this study have standard readability, good design and validated for efficacy.