To manage referrals to the pre-anesthetic consultation during the COVID-19 pandemic, a screening questionnaire was created and sent to parturients with anesthetic risk during the pre-anesthetic consultation. This innovative approach enabled the redistribution of medical anesthetic resources in units that were heavily affected by the pandemic.
Prior to the COVID-19 pandemic, our institution (Lausanne University Hospital) required future mothers to attend a pre-anesthetic consultation (PAC) only in cases of significant medical comorbidities or scheduled surgical intervention. The objectives of PAC are to anticipate the peripartum management of high-risk pregnant patients, select the optimal anesthetic technique, and address the appropriate postoperative follow-up. Prior to the visit, all patients were required, as an initial assessment, to complete a pre-anesthesia questionnaire (PAQ) and determine the indication for a PAC before delivery. This questionnaire is self-administered, but can also be completed with a resource person (e.g., an interpreter in the case of language difficulties).
In some countries, attendance to a PAC is mandatory. Switzerland, however, has no legal equivalence (1, 2). According to the Swiss Society of Anesthesia and Resuscitation (SSAR) standards, attendance to the PAC is optional and at the discretion of the principal care provider. Usually, the indication for an anesthesiology consultation is evaluated by the obstetrician (3). In contrast, for the anesthesia team, it is mandatory to obtain informed consent prior to surgery or intervention (4).
Currently, no PAC pricing exists in the Swiss healthcare insurance system. Thus, healthy patients with uncomplicated pregnancies and planned vaginal deliveries will not attend a PAC.
The COVID-19 pandemic has resulted in many adjustments to our current practices, such as hygiene measures, security of healthcare providers, and identification of high-risk parturients.
The redistribution of competent medical forces to the intensive care units has drastically reduced the availability of the PAC medical staff. To ensure the safety of our patients, the anesthesia and obstetrics teams of the Lausanne University Hospital proposed a screening questionnaire (modified PAQ) that allows for the selection of high-risk parturients and standardization of the referrals to PAC.
During obstetric consultations, obstetricians or midwives completed the modified PAQ with patients (Appendix 1 in Supplementary Material). This questionnaire, developed by our anesthesia team, combines the usual pre-anesthetic and bleeding diathesis items (5–10). To facilitate the referral process, some questionnaire items were sub-categorized into “code red” questions. In case of a positive answer to one or more “code RED” items, shared care with the anesthesiologist was implemented with the development of a specific care plan (e.g., complementary investigations, specialist referrals, admission the day before the intervention). On the contrary, if all “code RED” items were answered negatively, the patient was not required to attend a PAC and was assessed on the day of the intervention. A QR code (Appendix 2 in Supplementary Material) was created to facilitate the dissemination of this PAQ to other hospitals.
This PAQ was implemented during the second wave of COVID-19 (March 10, 2021 to June 15, 2021). During this period, 1,040 women gave birth at our institution and all of them were screened. The mean maternal age was 32.7 years, and 45% (N = 473) were primiparous. Of the participants, 13% (N = 138) gave birth prematurely and thus did not complete the PAQ.
A cesarean section (C-section) was performed in 21% (N = 222) of the births. Among them, 40% (N = 88) had an elective C-section, and all patients were screened using the PAQ. Following screening, 15% (N = 33) of the women were referred for a PAC. Only 5% (N = 52) of women who gave birth vaginally required a PAC after screening.
The current sanitary crisis implies the relocation of resources, with patient safety preservation as the priority. This procedure can be disseminated and assessed in cases with limited sanitary resources.
The original contributions presented in the study are included in the article/Supplementary Materials, further inquiries can be directed to the corresponding author/s.
EB and DD conceived of the presented idea. EB helped CG carry out the questionnaire. All authors discussed the results and contributed to the final manuscript.
Open access funding was provided by the University of Lausanne.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2022.770199/full#supplementary-materials
Pre-Anesthetic Questionnaire (PAQ).
QR Code download.
1. Journal Officiel de la République Française of December 6 (1994) 6:17383–5. Available online at: https://www.legifrance.gouv.fr/jorf/jo/1994/12/06/0282
2. Klopfenstein CE. La consultation pré-hospitaliére d'anesthésie en Suisse Francophone. Can J Anaesth. (1996) 43:317–8. doi: 10.1007/BF03011754
3. SGAR/SSAR. Standards et Recommandations pour l'Anesthésie. (2020). Available online at: https://sgar-ssar.ch/fileadmin/user_upload/sgarssar/public/Services/Richtlinien__Standards_und_Empfehlungen/SSAR_Standards_et_Recommandations_2020.pdf
4. SGAR/SSAR. Standards et Recommandations pour l'Anesthésie. (2020). Available online at: https://sgar-ssar.ch/fileadmin/user_upload/sgarssar/public/Services/Richtlinien__Standards_und_Empfehlungen/SSAR_Standards_et_Recommandations_2020.pdf
5. Bonhomme F, Ajzenberg N, Schved JF, Molliex S, Samama CM. Pre-interventional haemostatic assessment: guide- lines from the french society of anaesthesia and intensive care. Eur J Anaesthesiol. (2013) 30:142–62. doi: 10.1097/EJA.0b013e32835f66cd
6. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists task force on preanesthesia evaluation. Anesthesiology. (2012) 116:522–38. doi: 10.1097/ALN.0b013e31823c1067
7. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. Br Committ Stand Haematol Br J Haematol. (2008) 140:496–504. doi: 10.1111/j.1365-2141.2007.06968.x
8. Bonhomme F, Boehlen F, Clergue F, de Moerloose P. Preoperative hemostatic assessment: a new and simple bleeding questionnaire. Can J Anaesth. (2016) 63:1007–15. doi: 10.1007/s12630-016-0688-9
Keywords: anesthesiology, consultation, obstetrics, preoperative, questionnaire
Citation: Boussac E, Gery C and Desseauve D (2022) How to Adapt Anesthetic Human Resources to Health Emergencies Such as the COVID-19 Outbreak: Replacing a Pre-anesthetic Consultation With a Questionnaire in a University Obstetric Unit. Front. Med. 9:770199. doi: 10.3389/fmed.2022.770199
Received: 03 September 2021; Accepted: 11 April 2022;
Published: 18 May 2022.
Edited by:
Rebecca De Lorenzo, Vita-Salute San Raffaele University, ItalyReviewed by:
Gabriele Pascale, University of Salerno, ItalyCopyright © 2022 Boussac, Gery and Desseauve. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: David Desseauve, ZGF2aWQuZGVzc2VhdXZlJiN4MDAwNDA7Y2h1di5jaA==
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Emilie Boussac1
David Desseauve