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Preoperative questions

LOSPOR ships one catalogue of preoperative questions, versioned with the Hospital release. Each appliance has two profiles, one for adults and one for children, that say which of those questions its clinicians are asked, in what order, and which are required. A case follows the profile of its mode: an adult case the adult profile, a paediatric case the children's. Status changes each profile in place. There is no second definition source and there are no profile versions.

A question asked of both adults and children, such as latex allergy, has its own settings in each profile: it can be required for children and optional for adults, or switched off for one and on for the other.

Until 9.14.5 one profile served both. On the upgrade the children's profile starts as a copy of it, so nothing an administrator chose changes until they change it.

The catalogue​

The catalogue has 82 questions:

  • the 30 baseline questions (BASE_*) behind the standard form controls: allergies, family and personal anaesthetic history, dentition, habits, the RCRI, Apfel, STOP-BANG and POVOC factors, and the COLDS switch; and
  • 52 additions for adults and children, for example recent respiratory infection, exercise tolerance, falls, venous thromboembolism, abnormal bleeding, transfusion history, dysphagia, pacemaker or ICD, pregnancy, breastfeeding, prematurity, oxygen dependence and difficult venous access. Several have follow-up questions that are asked only after a Yes.

Added in 9.15.0, all off until an administrator switches them on:

  • Previous ICU admission, for adults and children.
  • Alcohol use, with follow-ups for heavy or daily drinking and previous withdrawal, asked only from 14 years: a younger patient's form, required check and summary leave it out.
  • Vaccination in the last 2 weeks, for children.
  • Abnormal bleeding and transfusion history, now asked of children too.
  • Gupta's functional status and procedure type, for adults. They are choice questions with their own options rather than Yes/No. With both on, the form shows the Gupta MICA cardiac risk card. Only the answers are stored; the risk is worked out from them, with the age, ASA and creatinine.

Each question has a fixed form section, a population (adult, pediatric or both), its answer options and its research code. None of this can be edited on the appliance. A new question or a changed definition needs a software release.

On a new installation the baseline questions are on, the additions are off, and every question is recommended rather than required. “Recommended” means that leaving it unanswered does not stop the clinician continuing to the intraoperative record. An administrator can make any individual switched-on question required; the setting is per question, not a blanket rule for all 30 baseline questions.

What an administrator can change​

From the preoperative form page in Status, an administrator picks Adults or Children and, for that profile, can:

  • switch a question on or off, including a baseline question;
  • make a switched-on question required or optional;
  • change the order of the added questions, by dragging or with the up and down buttons; and
  • preview the form in use.

Each view lists only the questions that population is asked. The baseline questions keep their fixed place in the form, next to the scores they feed, so they are listed apart from the added questions and cannot be moved; the order applies to the added questions within each form section.

Saving changes one profile, needs the administrator password and a reason, and is audited. The API refuses an incomplete list, duplicate positions, unknown questions, a question the population is never asked, and a question that is required while switched off.

What clinicians see​

The web app and the phone app, in both the tabbed and the scrolled layout, follow the profile:

  • a switched-on addition appears as a Yes/No row in its own form section, in the administrator's order, with Unknown or N/A where the question allows it;
  • a follow-up appears only when the question above it is answered Yes;
  • a required question carries an asterisk;
  • a suggestion drawn from the imported hospital record can be accepted or rejected, and is offered only while the question is unanswered; and
  • a switched-off baseline control is hidden, and a risk score that needs a switched-off answer says it is not available rather than showing a number that understates the risk.

The phone keeps the last profile it received, so the form stays the same offline.

Switching a question on or off​

A change applies to every case from its next load, including cases in progress:

  • a case starts asking a question that was switched on, and records it as not asked until someone answers;
  • a case stops asking a question that was switched off. An answer already given is kept and exported; an unanswered one leaves no row; and
  • a finalized case is never changed.

A draft always saves, whatever is unanswered. Required questions are checked when the clinician continues to the intraoperative record: the app lists the required questions still unanswered and stays on the preoperative form. Recommended questions remain visible and are recorded when answered, but do not block that transition. Finalization has a separate completeness check for the clinical sections; when it refuses a case, the web and phone explain the known missing section rather than displaying an internal protocol value.

Research​

Every question is stored as one answer row per case, and research and OMOP export read those rows. See Data & Research.