Abstract:
Anesthetists come in contact with more than two‑third of hospital patients. Timely referral to anesthetists is vital in perioperative
and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation,
perioperative complications, and poor outcome. Methods: The self administered paper survey to delegates attending anesthesia conferences.
Questions were asked on how high‑risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and
presence of rapid response teams. Results: The response rate was 43.8%. Sixty percent (55.3–64.8, P ‑ 0.001) reported high‑risk elective
cases were referred after admission. Sixty‑eight percent (63.42–72.45, P ‑ 0.001) opined preoperative resting echocardiographs were
useful. Six percent (4.16–8.98, P ‑ 0.001) reported emergency room referral before arrival of the patient. Twenty‑five percent (20.92–29.42,
P ‑ 0.001) indicated high‑risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more
commonly than residents (32% vs. 22%) (P ‑ 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40%
vs. 28%) (P ‑ 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) (P = 0.002). Remote site patients
were commonly referred to residents after sedation attempts (32% vs. 20%) (P = 0.036). Only 34.8 said hosptals where tbey practiced had
dedicated cardiac arrest team in place. Conclusions: Anesthetic departments must periodically assess whether subgroups of patients are being
referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals
must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits
must be encouraged.
