Preoperative anaesthesiological screening revised: breaking with the face‐to‐face dogma Acronym: DIGICA (DIGital Informed Consent in Anaesthesia)

In the Netherlands approximately 680,000 patients undergo a surgical procedure each year under general or regional anaesthesia or sedation‐analgesia [1]. Anaesthesia is exclusively provided by an Anaesthesiologist. It is the anaesthesiologist’s responsibility to prepare patients physically and mentally for the upcoming anaesthesia, to organize the care around the surgical procedures, to be as safe, comfortable, and efficient as possible, and to make sure patients remain comfortable and safe during the recovery period in the first 24 hours after an operation. Furthermore, the anaesthesiologist must enable the patient to give an informed consent for all the required anaesthesiological procedures. Before any procedure under general or regional anaesthesia can be scheduled, patients have to visit an outpatient Anaesthesiology clinic for preoperative anaesthesiological evaluation.

The newly established public private partnership between the department of Anaesthesiology of the Erasmus MC and NovaCair B.V. forms the basis for a successful implementation of DIGICA, our patient‐centred tailor‐made future‐proof preoperative anaesthesiological screening platform to facilitate care in the patient’s homeenvironment. With the development of DIGICA we aim to provide patients with tailor‐made information about the entire anesthesiological care path and provide the anaesthesiologist with the required information to safely provide anaesthetic care for the patient.

By successfully implementing this project the preoperative anaesthesiological care can be transformed to an extramural care path for those eligible, while maintaining a considerably downsized intramural care path for emergency surgery and patients otherwise not eligible for extramural care paths. This could result in a potential financial societal benefit of €14‐16M, which in turn can be invested in further development of tools to optimize the most frail patients in the broadest sense, babies on the one end and the elderly on the other end

After the successful ending of this project, we have delivered a framework which, in our view, points out what is necessary to have a successful digital screening and informed consent tool for preoperative anaesthesiologic screening. In more detail, we have delivered a “static” knowledge questionnaire (Rotterdam Anaesthesia Knowledge Questionnaire), several algorithms to either help patients choose the most fitting anaesthetic technique (if applicable when having a choice) based on psychological characteristics or help the physician with an automated ASA‐PS classification to be as uniform as possible. Furthermore, we have adapted the RAKQv1 to become a dynamic questionary to reduce patients’ burden even more, which will be published in 2025. Moreover we have shown in a large trial that patients are better informed about their planned aneasthesia using our solution while anxiety does not increase.

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