The Anesthesia Preparedeness Clinic (APC) triage score tool: an integrated electronic health record tool for improving resource allocation for preoperative care clinics

Abstract Pre-anesthesia clinics have been associated with improved patient outcomes, but with the rising surgical volume, there is a need to improve allocation of preoperative evaluations. We developed the Anesthesia Preparedeness Clinic (APC) Triage Score tool that was integrated into the electronic health record system and calculated a score based on preoperative factors. It was used to allocate preoperative evaluations for patients to either in-person, telehealth, or nursing phone screens. A retrospective cohort analysis was performed compare how resources were allocated prior to and after implementation (Pre-APC and Post-APC, respectively). There were a total of 9,986 and 10,487 surgical patients included in the analysis in the Pre-APC and Post-APC cohorts, respectively. The correlation coefficient between the triage score and American Society of Anesthesiologists Physical Status (ASA PS) score based on Spearmen test was 0.59 ( P < 0.001). The median (quartiles) APC Triage Score in patients who were ASA PS 1 was 0 (0, 1.5), ASA PS 2 was 3.0 (1.0, 6.0), ASA PS 3 was 9.5 (4.5, 17.0) and ASA PS 4 was 21.0 (11.5, 29.5). Patients that received an in-person visit tended to have higher APC Triage Scores in the Post-APC versus Pre-APC cohort with a median (quartiles) score of 17.0 (12.0, 25.5) versus 10.0 (6.0, 19.5), respectively ( P < 0.001). Patients that received a telehealth visit tended to have higher APC Triage Scores in the Post-APC versus Pre-APC cohort with a median (quartiles) score of 8.0 (5.0, 13.5) versus 7.0 (3.5, 13.0), respectively ( P < 0.001). Finally, patients that received a phone visit tended to have a lower APC Triage Score in the Post-APC versus Pre-APC cohorts with a median (quartiles) score of 3.0 (1.0, 7.0) versus 4.0 (1.0, 8.5), respectively ( P < 0.001). Our study demonstrated that implementation of the tool was associated with improved preoperative allocations.