Research into digital screening prior to surgery

If anesthesiologists Sander van den Heuvel and Jan-Wiebe Korstanje have their way, a large proportion of patients will conduct their preoperative consultations digitally in the future, eliminating the need to travel to Erasmus MC. However, the feasibility and desirability of this approach are first being investigated by them.

Grant

Korstanje and Van den Heuvel received a grant of nearly 1 million euros for this research from the Top Consortium for Knowledge and Innovation Health Holland. This organization challenges scientists to collaborate with businesses to develop technological solutions for complex healthcare challenges. The funding was awarded prior to the corona crisis. 'Since the crisis, the demand for a digital screening method has only increased,' says Sander van den Heuvel. 'Some hospitals are already handling a much larger volume of consultations over the phone in this area compared to before the crisis, but without clear insight into the consequences.'

Information

All patients scheduled for surgery are first required to attend the pre-anesthesia clinic. During this visit, they receive comprehensive information about procedures before, during, and after their hospital admission—such as fasting requirements, general anesthesia or spinal blocks, and other techniques applied during surgery. An anesthesiologist is a medical specialist dedicated to administering anesthesia to patients undergoing surgery or painful, invasive diagnostic procedures.

Choices

Van den Heuvel: 'Before a patient undergoes surgery, we make an assessment of the risks associated with the procedure—sometimes in consultation with the treating physician, and always in dialogue with the patient—along with advice on the best choices to make. To do this effectively, we need a clear picture of the patient's health status. Conducting such a consultation entirely over the phone is far from ideal. Did the patient truly understand what was communicated? And is the patient really as fit as they claim and believe themselves to be? Ultimately, the patient provides informed consent, granting permission for the medical treatment to be performed.'

At Erasmus MC, this concerns approximately 15,000 to 20,000 patients annually. Excluding travel time, these patients spend around an hour and fifteen minutes at the hospital for a twenty-minute consultation with the anesthesiologist, alongside visits to the pharmacy for medication verification, occasional ECGs or blood pressure measurements, and completing a health questionnaire if they have not already done so at home.

Knowledge assessment

'We believe that a large proportion of relatively healthy patients scheduled for surgery can complete these steps digitally from home using an intelligent questionnaire. This can be done at a time of their choosing, without the need to travel to Erasmus MC. At the same time, it is crucial to ensure they have fully understood the educational material. Therefore, in addition to digital health questionnaires, we will develop a form of knowledge assessment that becomes part of the patient record.'

Stumbling block

'A significant stumbling block is informed consent, as this currently still requires in-person contact. Some hospitals have patients grant approval just prior to surgery. While possible, we do not consider this an optimal situation. Individuals must be able to make a well-considered decision and be given sufficient time to reconsider or ask additional questions.' 

'Another crucial aspect is measuring patient satisfaction and safety throughout the entire process,' Van den Heuvel continues. 'We hope to complete our research within four years, using data from multiple hospitals during this period to monitor whether this approach leads to an increase in complications or postponed surgeries.' 

'Therefore, it will remain possible for patients to visit the clinic in person if they prefer, and naturally whenever we deem it clinically necessary based on their health status. Our ultimate objective is to create more time for severely ill patients who require more extensive evaluation before a surgical decision is made.'