1 The pre-operative clinic

The pre-operative examination is an indisputable duty of the anaesthesiologist. It can be performed in three different ways: the bed-side visit, the anaesthesiological consulting hour and the pre-operative clinic. The bed-side visit enables the anaesthesiologist scheduled for giving anaesthesia to introduce himself or herself to the patient. There is no additional cost for staff and equipment; however, the investigation is limited to a cursory interpretation of previous investigations and examinations. The best way to perform a pre-operative anaesthesiological examination is the pre-operative clinic. The staff of the pre-operative clinic comprises an anaesthesist, a nurse and a secretary. The examination is standardized and therefore easy to perform, easy to teach and easy to control. It includes an interview with the patient, a physical examination and the evaluation of several screening tests, if available (laboratory tests, chest X-ray, lung function and resting electrocardiogram). The complete examination enables the decision on whether the patient is fit for anaesthesia or not to be made. In a patient declared to be unfit the pre-operative condition has to be optimized and additional tests or consultants are required to rule out severe pre-operative diseases suspected on the basis of the pre-operative anaesthesiological investigation. If the suspicion is not confirmed, the patient proceeds to operation. If concomitant diseases are verified the surgical intervention is postponed until the patient's condition has been optimized. The costs of the pre-operative clinic are higher, mainly because of the need for additional anaesthesiological staff. However, as the pre-operative clinic enables a thorough and complete evaluation in most cases, it is the optimal presentation of the discipline anaesthesia. In our experience it plays a major role in quality management of patient care.