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

Minhthy N. Meineke; Alice Chien; Sophie W. Mawdsley; Megan Meyer; Brian H. Park; Elizabeth Kim; Rodney A. Gabriel

doi:10.1007/s10877-026-01438-8

April 16, 2026Journal of Clinical Monitoring and ComputingOpen Access

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

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Why the study?

Pre-anesthesia clinics improve patient outcomes, but rising surgical volume creates a need to improve the allocation of preoperative evaluations.

Does the implementation of an electronic health record-integrated triage score tool improve resource allocation for preoperative care clinics in surgical patients?

Key Points

To evaluate the performance and clinical utility of an electronic health record-integrated triage score tool for allocating surgical patients to in-person, telehealth, or telephone preoperative evaluations.
Retrospective cohort study comparing surgical encounters before (Pre-APC: August 1 to September 30, 2024; N=9,986) and after (Post-APC: April 1 to June 30, 2025; N=10,487) tool implementation.
The integrated algorithm calculated a triage score based on weighted diagnoses and medications to assign patients to in-person, telehealth, or registered nurse phone assessments.
The triage score correlated positively with American Society of Anesthesiologists Physical Status (ASA PS) score (Spearman correlation coefficient = 0.59, P < 0.001), with median (quartiles) scores of 0 (0, 1.5) for ASA PS 1, 3.0 (1.0, 6.0) for ASA PS 2, 9.5 (4.5, 17.0) for ASA PS 3, and 21.0 (11.5, 29.5) for ASA PS 4.
Patients evaluated in-person had significantly higher median (quartiles) triage scores in the Post-APC cohort compared to the Pre-APC cohort (17.0 [12.0, 25.5] vs 10.0 [6.0, 19.5], P < 0.001), as did patients evaluated via telehealth (8.0 [5.0, 13.5] vs 7.0 [3.5, 13.0], P < 0.001).
Patients evaluated via telephone screens had significantly lower median (quartiles) triage scores in the Post-APC versus Pre-APC cohort (3.0 [1.0, 7.0] vs 4.0 [1.0, 8.5], P < 0.001).

Structured PICO

Does the implementation of an electronic health record-integrated triage score tool improve resource allocation for preoperative care clinics in surgical patients?

P

Population

20,473 adult surgical patients (n=9,986 in Pre-APC cohort and n=10,487 in Post-APC cohort) evaluated at a pre-anesthesia clinic.

I

Intervention

Anesthesia Preparedness Clinic (APC) Triage Score tool integrated into the electronic health record system to allocate preoperative evaluations to in-person, telehealth, or nursing phone screens.

C

Comparator

Standard triage prior to implementation of the APC Triage Scoring System (Pre-APC period).

O

Outcome

Correlation of APC Triage Scores with clinician-assigned American Society of Anesthesiologists Physical Status (ASA PS) scores, and allocation of patients to visit types (in-person, telehealth, phone) based on score before and after implementation.

Implementation of an automated, EHR-integrated triage score for pre-anesthesia clinics improved the allocation of high-risk patients to in-person or telehealth visits and low-risk patients to phone screens, while reducing same-day surgical cancellations.

Limitations

Single-center study
Limited external validity and effectiveness at other institutions with alternative electronic health record systems

Implication

May permit virtual/phone triage for lower-risk patients; extends evidence for EHR-integrated scores to optimize preanesthesia allocation.

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.