Redesigning Pre-surgery Patient Journeys With Telehealth

April 15, 2025 updated by: KK Women's and Children's Hospital

Prior to surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. At the Preadmission Service (PAS) clinic of KK hospital, nurses perform the first triage to identify patients who require outpatient anaesthetic review in advance of surgery. While all elective patients attend the PAS clinic, only 8% are require outpatient anaesthetic review. The majority 92%, can be safely triaged to receive preanaesthesia assessment on the day of surgery. In this project, the investigators propose to investigate the efficacy of a new pre-surgery workflow for elective surgical patients incorporating telehealth. The investigators hypothesize that the redesigned pre-surgery journey incorporating telehealth reduces in-person consultation at the pre-admission clinic by up to 90%. Primary outcome is the proportion of eligible same-day-admission patients assessed via telehealth. Secondary outcomes are:

  1. Patient cost and time savings
  2. Patient experience of the new model of care
  3. Staff experience of the new workflow
  4. Incidence of day-of-surgery cancellations

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Prior to elective surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. Preadmission Service (PAS) clinic nurses at KK Hospital perform pre-surgery triage to identify patients requiring outpatient anaesthetic review. PAS data shows that only 8% of same-day-admission (SDA) patients needed an anaesthetist's review; the majority (92%) can be safely triaged to receive preanaesthesia assessment on the day of surgery. The aim of this study is to investigate the service re-design, efficacy and effectiveness of a new telehealth pre-surgery model of care for elective SDA patients. The investigators hypothesize that the telehealth pre-surgery new model of care will achieve an expected 50% uptake for SDA patients as the primary outcome during implementation. Secondary outcomes are patient cost savings, patient experience of the new model of care, and staff experience of the new workflow. The investigators will use a sequential exploratory mixed methods study design, consistent with the 5-stage model for telehealth research. An implementation science framework - the Normalisation Process Theory, underpins our 3-phase study. Phase 1 (service redesign) explores the feasibility of presrugery telehealth via semi-structured interviews of patients and healthcare staff. Phase 2 (preimplementation) investigates efficacy of the telehealth model of care by addressing service fidelity, and patient and staff experience using administrative data. Phase 3 is a pragmatic trial to ascertain effectiveness of the telehealthmodel of care, addressing the primary and secondary outcomes stated. This novel study using implementation science to redesign and implement presurgery telehealth will inform scale-up, spread, and sustainability of a new model of care within SingHealth and other health clusters in Singapore.

Study Type

Observational

Enrollment (Estimated)

258

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Singapore
      • Singapore, Singapore, 229899
        • KK Women's and Children's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patient participants are female patients booked for elective surgery at a tertiary women's hospital.

Healthcare participants are nurses, administrators, surgeons and anaesthetists working in the preoperative and surgeons' clinics at a tertiary women's hospital.

Description

Inclusion Criteria:

  • Patient participants:

Age 21 to 70 years Listed for elective surgery English literacy Willing to provide signed consent Of any nationality Able to give own legal consent

Exclusion Criteria:

  • Healthcare participants:

Age 21 to 70 years Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Patient participants

Patient booked for elective surgery and:

Age 21 to 70 years English literacy Willing to provide signed consent Of any nationality Able to give own legal consent
Other: Telehealth for preoperative evaluation
Conduct of preoperative evaluation remotely using Zoom application
Other Names:
  • Video consultation
Healthcare provider participants

Criteria:

  • Age 21 to 70 years
  • Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers)
  • working in the perioperative clinical areas
Other: Telehealth for preoperative evaluation
Conduct of preoperative evaluation remotely using Zoom application
Other Names:
  • Video consultation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of eligible elective surgery patients assessed successfully via telehealth for preoperative evaluation
Time Frame: One year from the initiation of the implementation phase (Phase 3)
Of the total number of patients booked for elective surgery, the proportion of patients evaluated preoperatively by telehealth is measured.
One year from the initiation of the implementation phase (Phase 3)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient's perception and attitude towards a Telehealth model of care for preoperative evaluation
Time Frame: 5 months from July to November 2021
Quantitative study via one-on-one semi-structured interviews of elective surgery patients to evaluate their attitudes and perception of the new proposed telehealth workflow conducted in (Service Redesign) Phase 1
5 months from July to November 2021
Healthcare providers' perception and attitude towards a Telehealth model of care for preoperative evaluation
Time Frame: 5 months from July to November 2021
Quantitative study via one-on-one semi-structured interviews of healthcare providers working in the peroperative and surgery clinics to evaluate their attitudes and perception of the new proposed telehealth workflow conducted in (Service Redesign) Phase 1
5 months from July to November 2021

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

KK Women's and Children's Hospital

Collaborators

Nanyang Technological University
Duke-NUS Graduate Medical School

Investigators

  • Study Chair: Chai-Rick Soh, FANZCA, Singapore General Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 13, 2021

Primary Completion (Actual)

December 31, 2024

Study Completion (Estimated)

December 31, 2026

Study Registration Dates

First Submitted

March 12, 2023

First Submitted That Met QC Criteria

March 12, 2023

First Posted (Actual)

March 23, 2023

Study Record Updates

Last Update Posted (Actual)

April 18, 2025

Last Update Submitted That Met QC Criteria

April 15, 2025

Last Verified

March 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • AM/HRT/008/2021

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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