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BJA Advance Access originally published online on March 31, 2008
British Journal of Anaesthesia 2008 100(5):645-651; doi:10.1093/bja/aen068
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors

L. C. Lemmens1,*, H. E. Kerkkamp1,5, W. A. van Klei1, N. S. Klazinga3, C. L. Rutten4, R. H. van Linge2 and K. G. Moons1,2

1 Department of Perioperative and Emergency Care, Q04.2.313
2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
3 Department of Social Medicine, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
4 Department of Anesthesiology, Weezenlanden Hospital, Isala clinics, PO Box 10500, 8000 GM Zwolle, The Netherlands
5 Present address: Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands

* Corresponding author. E-mail: l.lemmens{at}umcutrecht.nl

Background: Several studies have shown that outpatient preoperative evaluation by anaesthetists increases quality of care and is cost-effective. The aim of this study was to gain insight into the factors that positively or negatively influence the implementation of outpatient preoperative evaluation clinics (OPE clinics).

Methods: After an extensive literature study and pilot interviews, we constructed written questionnaires that were sent to all Dutch hospitals. The respondents were members of the board of directors, members of the medical staff, anaesthetists, internists, and surgeons.

Results: Cooperation of anaesthetists was most frequently mentioned as facilitating factor for implementation of an OPE clinic across all medical specialists interviewed. Lack of finance was most frequently reported as limiting factor in all categories of hospitals (with a complete, partial, or no OPE clinic), but it was significantly more often reported in hospitals without OPE clinic (P<0.01). Perceived benefits and disadvantages, financial rewarding system, and organizational structure played a clear role in the implementation of OPE clinics.

Conclusions: A variety of factors play a role in the implementation of an OPE clinic. Besides the more obvious ones, such as financing and cooperation of the professional groups involved, underlying factors, such as perceptions of the professionals involved, were found to be related to implementation of an OPE clinic. These underlying factors explain differences between different kinds of hospitals and between professional groups, regarding their resources and motivation to implement an OPE clinic.

Keywords: safety; screening; surgery, preoperative period


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Outpatient Preoperative Clinics : Our perspective
Somnath Bose
British Journal of Anaesthesia, 23 Apr 2008 [Full text]

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