Outpatient Pre-Anesthesla Consultation: Can an Expert System Help ?

Current medical reimbursement realities may limit the time an anesthesiologist can spend assessing complicated patients preoperatively. Third-party payers increasingly demand admission of sick patients for complex operative procedures on the day of surgery. These patients are often evaluated and counseled in outpatient preanesthesia consultation clinics several days before surgery by busy, semi-autonomous anesthesia paraprofessionals and trainees uninvolved in their actual operating room care. The efficient and careful evaluation and emotional preparation of such patients is extremely important on medico-legal and humanitarian grounds. An error or omission in the preoperative evaluation may have rapidly disastrous consequences in the operating room. This abstract describes the early development of a robust, computer-based environment (HyperCard-Based Operating Room Anesthesia Consultation Environment or "HORACE") to assist anesthesiology trainees, PAs, and CRNAs in the rapid, correct, thorough, and legible preoperative evaluation of patients presenting at these clinics. HORACE contains two components: 1) an efficient human-computer interface for generating preoperative evaluations, and 2) an integrated expert system for guiding the evaluation and patient consent processes. These components are now described in greater detail.