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Improving the Yield of an Antenatal Anesthesia High-Risk Consultation Service: Development and Assessment of a Screening Tool
Abstract Number: T-33
Abstract Type: Original Research
Antenatal anesthesia high-risk consultation (HRC) of patients with medical comorbidities can optimize patient conditions, enable team-based decision-making, and allow advanced anesthetic planning (1). Patient factors that are associated with an antenatal change in management (CIM) are poorly understood. The purpose of this study was to define such factors and develop a screening tool to identify patients who may benefit from antenatal HRC.
Records from our high-volume obstetric anesthesia HRC service over a two and a half-year period were reviewed. CIM was defined as requesting consultation from another specialty, ordering radiologic studies, requesting existing images or records from an outside hospital, or reviewing the internal patient record for more information than is routinely obtained during the pre-anesthesia evaluation. The association between patient factors and antenatal anesthetic CIM was assessed by univariate analyses, followed by multivariate adjustment using logistic regression. The ability of an existing, clinically validated, screening tool from our hospital’s preoperative clinic to identify patients requiring a CIM was evaluated.
Data were collected from 612 consecutive HRCs. Significant multivariate predictors of a CIM included maternal cardiovascular (p<0.001) or neurologic (p=0.008) issues, absence of major obstetric issues (p<0.001), and lower gestational age at the time of HRC (p<0.001). The presence of at least one factor from the screening tool was also associated with a CIM: 45.6% of patients with a positive screen vs. 34.7% of patients with a negative screen; (p=0.009).
Utilization of the HRC service has increased as patient comorbidities have become more prevalent (2). While inadequate recognition and mismanagement of high-risk parturients may contribute to maternal morbidity and mortality, overutilization of the HRC for low-risk patients has cost and manpower implications. We have identified patient factors that triggered a CIM following HRC and modified a screening tool to reflect these factors. Further sensitivity and specificity analysis will enable the development of a screening tool that will be externally valid. The ability of a HRC service to efficiently capture at-risk patients and prevent adverse outcomes is an important aspect of healthcare cost containment, particularly as maternal morbidity increases.
1.Butwick et al. IJOA 2007
2.Moffitt D et al. NE