Effect of Virtually Led Value-Based Preoperative Assessment on Safety, Efficiency, and Patient and Professional Satisfaction

Background Increasing demand for elective surgery makes optimizing preoperative assessment a priority. Value-based healthcare aims to provide the highest value for patients at the lowest possible cost through various mechanisms including reorganizing care into integrated practice units (IPUs). However, few studies have analyzed the effectiveness of implementing virtually led IPUs for preoperative assessment. Methods We performed a retrospective observational cohort study including patients undergoing elective surgery at a teaching hospital in Madrid, Spain from January 1 st , 2018, to December 31 st , 2023, analyzing changes in surgical complications, efficiency, and patient satisfaction between the preimplementation (2018-2019) and postimplementation (2020-2023) periods. Anesthesiologist satisfaction with virtual assessment was described. During the postimplementation period, preoperative assessment was reorganized as a virtually led IPU. At the IPU appointment, preoperative testing and physical (including airway) examination was performed by a nurse anesthesiologist. Results were uploaded to the electronic health record and asynchronous virtual anesthesiologist assessment using a store-and-forward approach was performed. Digital patient education was carried out over the Patient Portal mobile application. Results A total of 40,233 surgical procedures were included, of which 31,259 were from the postintervention period. During the postintervention period, no increase in surgical complications was observed, while same-day cancellations decreased from 4.3% to 2.8% of total procedures (P<0.001). Overall process time did not increase, despite the rising number of surgical procedures per year. Patient satisfaction improved. Median time to complete anesthesiologist assessment was significantly lower for virtual assessment (4.5 versus 10 minutes (P<0.001), signifying estimated time savings of 716 person-hours per year. Anesthesiologists agreed that virtual assessment was more efficient that in-person evaluation, and half of participants agreed that virtual preoperative care improved work-life balance and reduced burn-out. Conclusions A digitally enhanced value-based model of preoperative care can improve efficiency and satisfaction metrics, reducing unnecessary costs and potentially improving quality of care.