Holistic streamlined surgery patient perioperative risk assessment tool

Unmet Need

Surgery poses major burdens for hospitals and patients. As of 2023, there are 6,129 hospitals in the United States performing a staggering 50 million surgeries each year. Despite the increased scrutiny on the efficiency and cost of perioperative care, typical hospital settings have a fragmented care system that is prone to delays and miscommunication. Pre-surgery, the patient has a brief pre-admission test with the screening clinic. If a concern is identified, they are advised to see a primary care doctor for medical clearance. If not cleared immediately, the patient may then be referred to specialists for intervention programs such as diabetes management and smoking cessation, which may cause a 3-month delay to the surgery. Post-surgery, it is estimated that 1-4% of the patients will die, up to 15% will have serious postoperative morbidity, and 5-15% will be readmitted within 30 days. Optimizing pre-surgery patient risk assessment would protect patients from post-surgical complications, accelerate the continuum of perioperative care from diagnosis to recovery, and save billions of dollars in healthcare costs. There is a need for a surgery patient risk assessment system that achieves better health outcomes with greater efficiency and lower cost.

Technology

A team of inventors at Duke’s Preoperative Anesthesia Surgical Screening (PASS) clinic have developed a decision-support system that stratifies the level of risk a patient faces in surgery. This is intended to be used by healthcare professionals to determine the type of perioperative anesthesia and surgical screening suitable for each patient based on their medical records. Using PASS’s holistic approach, this decision-support tool evaluates patients’ overall medical, physical, and physiological readiness for procedures, anticipates changes induced by surgery and anesthesia, and takes into account comorbidities, social determinants, and the urgency of the procedures. After curating medical conditions across specialties, the inventors distilled the most relevant aspects of patients’ medical histories and detailed the ranges of each condition to determine the appropriate appointment intervention type, including an in-person visit, app virtual consultation, and registered nurse phone screen. Patients who face low risk only need a phone screen, while patients who face higher risk need a virtual consultation or an in-person visit to participate in Duke’s PeriOperative Enhancement Teams (POET) intervention optimization program. Directing patients to the appropriate PASS appointment type allocates healthcare resources more efficiently. The implementation of the inventors’ decision-support tool in the PASS-POET model has dramatically accelerated the continuum of perioperative care from diagnosis to recovery, decreased the clinic no-show rate through virtual options, and allowed PASS to serve as many as 50,000 diverse patients each year. The vast amount of data at PASS has further driven the inventors to iteratively improve their tool to better support older, medically complex, frail, and socioeconomically underprivileged patients. The inventors’ decision-support tool could be developed into powerful software for Duke University’s health system and beyond.

Advantages

• More holistic than typical clinical settings, which tend to only consider patients’ chronic conditions when assessing perioperative risk
• More detailed and focused than existing healthcare software
• Accelerates the entire continuum of perioperative care from diagnosis to recovery through coordination and streamlining
• Reduces personal costs and costs to the health system
• Optimized iteratively through data
• Built with the expertise of the unique, large-scale, internationally renowned, and influential Duke PASS-POET program and demonstrated success