[Janae Ingraham]

Anesthetic Pre-Operative Assessment:

A telehealth program I would like to develop and participate in as a CRNA would focus specifically on pre-operative anesthesia assessment for pediatric patients. Children scheduled for surgery frequently experience day-of-procedure cancellations due to unrecognized upper respiratory infections, poor NPO compliance, unmanaged asthma, anxiety, or lack of preoperative education. A telehealth-based assessment model would improve readiness, reduce surgical delays, and support families in navigating the perioperative process more confidently.

I would use a combined telehealth model incorporating videoconferencing + mHealth + selective store-and-forward capabilities. Live videoconferencing would allow me to visually assess respiratory effort, work of breathing, presence of cough, review history, medications, allergies, prior anesthetic experiences, and screen for markers of difficult airway. Parents could upload photos, PCP notes, pulmonary clearance letters, medication lists, or growth charts using a secure store-and-forward system. mHealth tools could track asthma symptoms, fever trends, sleep quality, and symptom progression in the days before surgery, improving real-time decision-making.

The program would target pediatric patients ages 6 months to 17 years, with emphasis on children who are anxious, neurodivergent, or medically complex. My role would be to conduct virtual assessments, provide anticipatory guidance, reinforce NPO and medication instructions, evaluate airway risk, and determine whether the child is optimized or requires postponement or medical clearance.

Program evaluation would measure surgical cancellation rates, parental satisfaction, pre-operative compliance, and safety outcomes such as respiratory complications or PACU admissions. Legally, all communication would occur through HIPAA-compliant platforms, and licensure requirements across state lines would be strictly followed. Telehealth consent would be obtained electronically and verbally prior to each visit, clarifying privacy protections, technology risks, limitations of virtual airway evaluation, data storage, and the circumstances under which in-person assessment would be required. Parents would sign, and when developmentally appropriate, the child would provide assent.

I would collaborate with pediatricians, ENT, pulmonology, child-life specialists, and perioperative nursing. Standardized protocols would outline URI symptom criteria, asthma optimization pathways, medication management, and escalation indicators.

Through structured virtual evaluation, this telehealth model has the potential to make pediatric anesthesia safer, more accessible, and family-centered.

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