Perceptions and Attitudes of Patients and Health Care Stakeholders on Implementing a Telehealth Service for Preoperative Evaluation: A Qualitative Analysis.

Background: Studies suggest that preoperative evaluation can be effectively conducted through telehealth. As the COVID-19 pandemic has accelerated digital transformation, we hypothesize that a new telehealth model of care may be feasibly implemented for preoperative evaluation at our institution. This qualitative study seeks to evaluate the attitudes and perception of elective surgery patients and health care providers toward telehealth conducted for preanesthesia evaluation. Methods: At a tertiary women's hospital in Asia, health care providers and elective surgery patients were recruited by convenience and snowball sampling to undergo one-on-one semistructured interviews regarding a new telehealth model of care for preanesthesia evaluation, under-pinned by the Normalization Process Theory. Data were analyzed, coded, and consolidated into themes using the framework analysis method by a team of four researchers from diverse backgrounds. Results: Twenty-five interviews were conducted among 10 patients and 15 health care participants. Ninety-five codes were identified, consolidated into four themes that connect to guide the implementation of a new telehealth pathway for preoperative care, mapped to the Normalization Process Theory. The themes pertain to advantages of telehealth workflow (coherence), requisites for new telehealth workflow (coherence, collective action), barriers to implementation (cognitive participation, collective action), and enablers of implementation (cognitive participation, collective action). All participants were receptive to telehealth, but health care participants expressed concern about the impact of additional tasks on current clinical workload. Training in videoconferencing was deemed essential by both patients and health care providers. Conclusions: The study has provided insights into levels of coherence and cognitive participation among patients and health care providers. The telehealth workflow should be redesigned, considering systems' constraints and stakeholders' needs. Greater buy-in is needed to gain health care providers' commitment for collective action. Clinicaltrials.gov identifier: NCT05781789.

Delphi consensus on the American Society of Anesthesiologists' physical status classification in an Asian tertiary women's hospital.

BACKGROUND: The American Society of Anesthesiologists (ASA) score is generated based on patients' clinical status. Accurate ASA classification is essential for the communication of perioperative risks and resource planning. Literature suggests that ASA classification can be automated for consistency and time-efficiency. To develop a rule-based algorithm for automated ASA classification, this study seeks to establish consensus in ASA classification for clinical conditions encountered at a tertiary women's hospital. METHODS: Thirty-seven anesthesia providers rated their agreement on a 4-point Likert scale to ASA scores assigned to items via the Delphi technique. After Round 1, the group's collective responses and individual item scores were shared with participants to improve their responses for Round 2. For each item, the percentage agreement ('agree' and 'strongly agree' responses combined), median (interquartile range/IQR), and SD were calculated. Consensus for each item was defined as a percentage agreement ≥ 70%, IQR  1.0, and SD < 1.0. RESULTS: All participants completed the study and none had missing data. The number of items that reached consensus increased from 25 (51.0%) to 37 (75.5%) in the second Delphi round, particularly for items assigned ASA scores of III and IV. Nine items, which pertained to alcohol intake, asthma, thyroid disease, limited exercise tolerance, and stable angina, did not reach consensus even after two Delphi rounds. CONCLUSIONS: Delphi consensus was attained for 37 of the 49 study items (75.5%), facilitating their incorporation into a rule-based clinical support system designed to automate the prediction of ASA classification.

Modern neuraxial labour analgesia.

PURPOSE OF REVIEW: Neuraxial analgesia is considered the gold standard of labour analgesia as it provides the most effective method of pain relief during childbirth. In this article, we explore the recent advances in the initiation and maintenance of epidural analgesia. RECENT FINDINGS: Patient-controlled epidural analgesia, computer-integrated patient-controlled epidural analgesia, intermittent epidural bolus (programmed intermittent bolus, automated mandatory bolus) and variable frequency automated mandatory bolus administration are techniques that allow the individualized titration and optimization of labour analgesia. The debate has moved on to finding the optimal settings for epidural bolus dosing, time intervals and frequency for epidural analgesia with the hope of improving safety and efficacy as well as patient satisfaction. SUMMARY: We examine these recent developments in pump technology and epidural delivery systems and evaluate how these have enhanced the mothers' birthing experiences.