Research into digital screening for surgery

If it is up to anesthesiologists Sander van den Heuvel and Jan-Wiebe Korstanje, in the future, a large proportion of patients will make a digital visit to the consultation hour before an operation takes place. Patients will then no longer need to come to Erasmus MC for this. But whether that is possible and wise will first be investigated by them.

Grant

Korstanje and Van den Heuvel received a nearly 1 million euro grant for this research from the Top Consortium Knowledge and Innovation Health Holland. This is a body that challenges scientists to work with companies to come up with technological solutions to complex issues in healthcare. The amount was awarded before the corona crisis. 'Since the crisis, the demand for a digital screening method has only increased,' says Sander van den Heuvel. 'Because of the crisis, some hospitals are already doing much more on the phone in this area than before the crisis, but without having a view of the consequences.'

Information

All patients undergoing surgery always visit the pre-operative consultation first. There they receive comprehensive information about what to do before, during and after their hospitalization. About staying sober, anesthesia or an epidural as anesthesia and other techniques used during surgery.The anesthesiologist is a medical specialist who deals with giving anesthesia to patients who have to undergo surgery or a painful, stressful examination.

Choices

Van den Heuvel: "But before a patient is operated on, we make an assessment, sometimes in consultation with the practitioner, and always in consultation with the patient, of the risks involved in such an operation and advice on what choices they can best make. To do this, we must have a good view of the patient's health. Having such a conversation over the phone is not ideal. After all, did the patient understand what was said? And is the patient really as fit as he or she thinks and says? In the end, the patient gives an informed consent, or permission to carry out the medical treatment.'

At Erasmus MC, this quickly amounts to 15,000 - 20,000 patients per year. These patients spend about 45 minutes in the hospital, not counting their travel time. For a twenty-minute interview with the anesthesiologist, but also to visit the pharmacy to check their medication, sometimes for a heart monitor or blood pressure measurement, and to fill out a questionnaire about their health, if they have not already done so at home.

Knowledge Test

'We believe that a large proportion of the relatively healthy patients who need surgery can go through these steps digitally from home using an intelligent questionnaire. This can then be done at a time of their own choosing and without a trip to Erasmus MC. However, it is important to make sure that they have understood the information properly, so in addition to questionnaires about their health that they must be able to complete digitally, we will develop a kind of knowledge test that will become part of the patient file.'

Stumbling block

'One stumbling block is informed consent, because that currently still requires physical contact. Some hospitals have patients give their consent just before they are operated on. That can be done, but in our view is not an optimal situation. Someone must make a well-considered decision and be given time to come back to it or ask additional questions.'

'Another important aspect is measuring patient satisfaction and safety throughout the process,' Van den Heuvel continues. 'We hope to complete our research within four years and in that time monitor, using data from more hospitals, whether this, for example, increases complications or postpones operations.'

'So it remains possible for the time being for patients to come in, if they want to and, of course, if we think it is necessary because of the patient's health. Our principle is to have more time in the future because of this for seriously ill patients for whom it is important to do more research before we decide to operate.'