Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic
Elevated preoperative blood pressure (BP) is a common problem and often results in late surgery cancellation and wastage of theatre resources. High BP readings in the preoperative anaesthetic assessment clinic (PAAC) could be the result of the white coat effect (WCE) and may not reflect patients’ ba...
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| Language: | English |
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BMJ Publishing Group
2025-07-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/3/e003097.full |
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| author | Xinyan Zhang Xuan Han Koh Shuhuei Neo Avinash Gobindram Anne S C Kiew Eeteng Ong |
| author_facet | Xinyan Zhang Xuan Han Koh Shuhuei Neo Avinash Gobindram Anne S C Kiew Eeteng Ong |
| author_sort | Xinyan Zhang |
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| description | Elevated preoperative blood pressure (BP) is a common problem and often results in late surgery cancellation and wastage of theatre resources. High BP readings in the preoperative anaesthetic assessment clinic (PAAC) could be the result of the white coat effect (WCE) and may not reflect patients’ baseline BP. A preliminary audit conducted in our hospital revealed a significant number of unnecessary referrals to the general practitioners (GPs) and the emergency department (ED) based on high BP readings in PAAC alone.This study aimed to determine the prevalence of WCE in elective surgical patients and develop a workflow to reduce unnecessary referrals and case cancellations.A multidisciplinary team established a new hypertension workflow by introducing home BP monitoring and involving internal medicine specialists in perioperative care. 214 patients with clinic BP higher than 160/90 mm Hg in PAAC were recruited. They were instructed to check their home BP twice a day with a machine on loan from PAAC and seek medical assistance if their home BP exceeded 160/90 mm Hg. WCE was diagnosed when the discrepancy between the average clinic BP and home BP exceeded 20/10 mm Hg.WCE was observed in 92.1% of patients (162/176, 95% CI 87.0 to 95.6) and 57.4% of those with WCE (57.4%, 95% CI 49.7 to 64.8) had normal home BP measurement. None of the patients had surgery cancelled due to high BP readings on the day of the operation, and the number of unnecessary GP/ED referrals was significantly reduced after implementation of the new workflow.The comprehensive perioperative workflow using home BP monitoring offers an effective and feasible method to detect WCE. This approach has saved healthcare resources and improved patient satisfaction. |
| format | Article |
| id | doaj-art-cd751d2e07f74e24bee5ff27e2d5eebf |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-cd751d2e07f74e24bee5ff27e2d5eebf2025-08-20T03:51:29ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-07-0114310.1136/bmjoq-2024-003097Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinicXinyan Zhang0Xuan Han Koh1Shuhuei Neo2Avinash Gobindram3Anne S C Kiew4Eeteng Ong5Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, SingaporeDepartment of Health Service Research, Changi General Hospital, SingaporeDepartment of Anaesthesia and Surgical Intensive Care, Changi General Hospital, SingaporeDepartment of Anaesthesia and Surgical Intensive Care, Changi General Hospital, SingaporeDepartment of Anaesthesia and Surgical Intensive Care, Changi General Hospital, SingaporeDepartment of Anaesthesia and Surgical Intensive Care, Changi General Hospital, SingaporeElevated preoperative blood pressure (BP) is a common problem and often results in late surgery cancellation and wastage of theatre resources. High BP readings in the preoperative anaesthetic assessment clinic (PAAC) could be the result of the white coat effect (WCE) and may not reflect patients’ baseline BP. A preliminary audit conducted in our hospital revealed a significant number of unnecessary referrals to the general practitioners (GPs) and the emergency department (ED) based on high BP readings in PAAC alone.This study aimed to determine the prevalence of WCE in elective surgical patients and develop a workflow to reduce unnecessary referrals and case cancellations.A multidisciplinary team established a new hypertension workflow by introducing home BP monitoring and involving internal medicine specialists in perioperative care. 214 patients with clinic BP higher than 160/90 mm Hg in PAAC were recruited. They were instructed to check their home BP twice a day with a machine on loan from PAAC and seek medical assistance if their home BP exceeded 160/90 mm Hg. WCE was diagnosed when the discrepancy between the average clinic BP and home BP exceeded 20/10 mm Hg.WCE was observed in 92.1% of patients (162/176, 95% CI 87.0 to 95.6) and 57.4% of those with WCE (57.4%, 95% CI 49.7 to 64.8) had normal home BP measurement. None of the patients had surgery cancelled due to high BP readings on the day of the operation, and the number of unnecessary GP/ED referrals was significantly reduced after implementation of the new workflow.The comprehensive perioperative workflow using home BP monitoring offers an effective and feasible method to detect WCE. This approach has saved healthcare resources and improved patient satisfaction.https://bmjopenquality.bmj.com/content/14/3/e003097.full |
| spellingShingle | Xinyan Zhang Xuan Han Koh Shuhuei Neo Avinash Gobindram Anne S C Kiew Eeteng Ong Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic BMJ Open Quality |
| title | Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| title_full | Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| title_fullStr | Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| title_full_unstemmed | Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| title_short | Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| title_sort | implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic |
| url | https://bmjopenquality.bmj.com/content/14/3/e003097.full |
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