Pre‐operative assessment clinics – the last word

I have followed with interest the recent correspondence regarding pre-anaesthetic assessment clinics [1-5], which discusses many of the merits and pitfalls of such a system. Within this discussion, however, I feel that one important aspect requires greater emphasis. For effective pre-operative assessment, anaesthetist-run clinics should not operate in isolation, but should be one component of a larger system that co-ordinates the various aspects of an elective surgical admission. In our institution, pre-assessment begins with a written health questionnaire, which is sent to the patient at home as soon as they are listed for surgery. Completed questionnaires are screened by clerical staff using predetermined criteria and if necessary by an anaesthetist. The patient is then classified into one of the following categories: 1 requiring review in the Perioperative Clinic; 2 no further review required (until the day of surgery). In addition, clinic attendance can be arranged at the request of either patient or surgeon. As the majority of patients presenting for elective surgery neither wish for nor require a detailed anaesthetic consultation, this ‘filtering’ process means that only those patients who really need to be seen visit the clinic. The benefits which Dr Cosgrove attributes to Preassessment Clinics [1] were actually conferred by the implementation of this peri-operative system [2]. This may seem overly pedantic, but I feel it is a point worth stressing. If a novel approach to pre-operative assessment is implemented in the UK, I feel that such a radical approach is warranted, not just a change in timing and venue of the standard pre-anaesthetic visit. Like Dr Cosgrove, I am experiencing this system as a visitor to Australia. While it is by no means perfect, it is superior to the situation I have often experienced in UK hospitals where an unexpectedly complex patient presents on the day of surgery, resulting in a hurried (and often chaotic) ‘workup’.