It is common practice in primary care to “clear” our patients for surgery, but we are not alone as our colleagues in internal medicine and anesthesiology frequently perform the same duty. Not a week goes by in my practice, and likely daily for my anesthesia colleagues, that patients bring paperwork from a surgeon asking for clearance. The question for many is what needs to be done? It is all too tempting to do too much in order that a patient’s procedure won’t be cancelled because someone forgot to order “X” test. Furthermore, many providers have had little formal education in performing preop evaluations. However, there are several evidence-based guidelines to help sort out the myriad of options.
Just deciding whether or not a patient is “safe” to proceed to the operating room is not enough. With today’s complicated medication regimens including various anticoagulation options, deciding what medications should be continued on the day of surgery or held (and for how long pre/post op) are very intimidating questions for providers to answer in the typical 20 minute appointment!
Previously here on iMedicalApps we reviewed a wonderful medical app by Dr Joshua Steinberg called Preop Eval designed to assist providers in making these complicated decisions a lot easier. A more recent addition to the app store to assist providers in preoperative clearance is PreOpGuide from TEAM Health Anesthesia, a group of anesthesia providers that are part of the larger TEAM Health clinical outsourcing company. The content of PreOpGuide is set up to be completed like a patient questionnaire.
The questions are arranged by system from pulmonary to neurology followed by additional questions that address social issues such as alcohol and/or drug abuse, medications, and finally the type of surgery. Along the way, the app has a number of “information” icons to help clarify each question and assist the user in obtaining the salient information. Finally, you click on the “submit” button and the app generates a preop plan for the patient detailing what preop tests should be ordered and whether or not a more robust cardiac clearance is indicated. The app gives you the option of printing the results or starting the next preop eval.
Let’s walk through the app via a clinical case similar to one I saw in clinic recently. A 45 year-old obese female with a BMI of 36 presents in clinic for a preop eval prior to undergoing bariatric surgery. Her past medical history is complicated by Type II diabetes, hypertension, hyperlipidemia, and a stroke ten years ago while she was taking oral contraceptives. She is on a number of medications including metformin, ramipril, atorvastatin, and clopidogrel. Now let’s try out PreOpGuide to see what needs to be done to “clear” her for surgery.
Evidence based medicine:
The app appears to use evidence based guidelines for its recommendations, but they are not clearly stated anywhere in the app. Does the app follow the 2014 American College of Cardiology (ACC) & American Heart Association (AHA), the 2012 American College of Chest Physicians (ACCP), the 2011 European Society of Anesthesiology (ESA), and/or the 2014 Institute for Clinical Systems Improvement (ICSI) guidelines like Preop Eval does? I simply can’t tell from any of the information given in the app though the press release for PreOpGuide states that it does.
What providers would benefit from this App?
Residents, mid-levels, Family Medicine, Internal Medicine, General Surgeons, Anesthesiologists, Nurse Anesthetists and any other provider who performs preop evals.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Patient questionnaire interface that can be completed rapidly at the point of care.
- Systems based algorithms that include prompts at each step to aid completion.
- Seemingly “complete” preop summary generated that can be printed for the patient/provider and/or added to the medical record.
- Minimal information about the app developers.
- No information about the evidence/guidelines upon which app is based.
- Inability to save data to the app.
- Not available for Android.
An intriguing, easy to use tool to perform preop evals at the point of care. It’s unfortunate this app does not include more information about the guidelines and evidence that is utilized “under the hood” of this app. I am concerned the app could be “leaving” something out.
- Overall Score
- User Interface
Quick, easy to complete by virtually anyone and includes ability to print the eval from the app.
- Multimedia Usage
Lacks links to other calculators, omits references, no ability to save data in the app, but you can print results.
A good resource for free.
- Real World Applicability
Applicability is limited by the lack of information about the app’s sources/evidence/guidelines.
- Device Used For Review
iPhone 6 running iOS 8.4.1.
- Available for DownloadiPhoneiPad