• Richard H Epstein, Franklin Dexter, Eric S Schwenk, and Thomas A Witkowski.
• Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, Miller School of Medicine, 1400, NW, 12th Avenue, Suite 3075, Miami, Florida 33136, United States; Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States. Electronic address: repstein@med.miami.edu.
• J Clin Anesth. 2017 Sep 1; 41: 112-119.

Study ObjectiveWe evaluated 4 hypotheses related to bypass of an anesthesiologist-directed preoperative evaluation clinics (APEC): 1) first-case tardiness and turnover times increased; 2) turnover times increased more than first-case tardiness; and higher American Society of Anesthesiologists Physical Status (ASA PS) resulted in both an ordered increase among ASA PS and within ASA PS in 3) first-case tardiness; and 4) turnover times.DesignRetrospective observational study using electronic health records.SettingOne large, teaching hospital.PatientsAn average of 14,310 patients per year undergoing elective surgery in the hospital's main opera rating rooms who were not inpatients preoperatively between 2006 and 2016.InterventionsNone.MeasurementsAverage increases in first-case tardiness and turnover times between patients seen or not seen preoperatively in the APEC.Main ResultsAPEC bypass increased first-case tardiness 2.58 min per case (CI 1.55-3.61; P<0.0001) and turnover times by 7.49 min (CI 6.79-8.19; P<0.0001). The increase in mean turnover time was greater than mean first-case tardiness (difference=4.91 min; CI 3.76-6.06; P<0.0001). Had all patients bypassed the APEC, the increase in total minutes OR- 1 workday- 1 for turnover times would have been larger than the increase in first-case tardiness (difference=5.71, CI 3.17-4.72; P<0.0001). There was an ordered increase with APEC bypass for both first-case tardiness and turnover times with increasing ASA PS (P<0.0001). Within ASA PS, first-case tardiness (all P-values<0.003) and turnover times (all P-values<0.0001) also increased with APEC bypass. All 4 hypotheses were accepted.ConclusionsOverall and with control for ASA PS, APEC bypass increases first-case tardiness and turnover times. A strategy of selective bypass of ASA PS 1-2 patients would not be effective economically because of substantial delays from ASA PS 2 patients.Copyright © 2017 Elsevier Inc. All rights reserved.

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