Key findings:

The study found that adopting a brainstorming strategy plays a significant role in achieving organizational excellence. Key findings include a positive correlation between brainstorming and organizational excellence, and that brainstorming exercises a moral influence in achieving excellence.

What is known and what is new?

The study explores the relationship between brainstorming and organizational excellence in a university setting. Known is the importance of brainstorming in generating ideas and improving organizational performance. New is the specific focus on examining the influence of brainstorming on achieving organizational excellence, providing insights into the effectiveness of this strategy in a governmental university context.

What is the implication, and what should change now?

The study highlights the need for improved patient education and awareness regarding Pre Anesthetic Check Up (PAC) to ensure better preparedness and perioperative outcomes. Healthcare providers should prioritize preoperative counseling, provide accessible educational materials, and conduct targeted campaigns to address the identified barriers, particularly in regions with challenging geographic and demographic factors.

The Pre Anesthetic Check Up (PAC) is a critical component of the perioperative care process, designed to ensure that patients are adequately prepared for anesthesia and subsequent surgery. It involves a thorough assessment of a patient's medical history, physical examination, and necessary investigations to identify any potential risks that could complicate the anesthesia process. The primary goal of PAC is to optimize the patient's condition before surgery, minimize perioperative complications, and enhance overall surgical outcomes. Despite its importance, there remains a significant gap in the awareness and knowledge of PAC among patients scheduled for surgery. [1-3]

At Pt Jawahar Lal Nehru Government Medical College in Chamba, Himachal Pradesh, the role of PAC is particularly vital given the institution's commitment to delivering high-quality healthcare services in a region characterized by challenging geographic and demographic factors. Chamba's mountainous terrain and remote location can limit access to specialized medical care, making it imperative that patients are well-informed and adequately prepared for surgical procedures. Understanding patients' awareness and knowledge about PAC is crucial for improving their engagement in the perioperative process and ensuring better health outcomes.

Proper knowledge and awareness of PAC among patients can significantly impact their preoperative preparation and postoperative recovery. Informed patients are more likely to follow preoperative instructions, such as fasting guidelines and medication adjustments, which are essential for safe anesthesia administration. Additionally, they are better equipped to provide accurate medical histories and disclose relevant health information, enabling anesthesiologists to tailor anesthesia plans to individual needs. This proactive participation can reduce the risk of anesthesia-related complications, decrease anxiety, and enhance patient satisfaction. [4-6]

However, previous studies have indicated that many patients have limited understanding of PAC and its significance. Factors contributing to this lack of awareness include insufficient communication between healthcare providers and patients, lack of targeted educational initiatives, and patients' varying levels of health literacy. Addressing these issues is essential for fostering a more informed patient population and improving perioperative care quality. [7-10]

In the context of Pt Jawahar Lal Nehru Government Medical College, assessing the level of awareness and knowledge about PAC among patients coming for surgery is vital for identifying gaps in patient education and developing effective strategies to bridge these gaps. Such an assessment can provide valuable insights into patients' perceptions and experiences, highlighting areas where additional support and information are needed. By understanding these dynamics, healthcare providers can implement tailored interventions, such as educational campaigns, preoperative counseling sessions, and informational materials, to enhance patients' understanding of PAC.

By evaluating patients' current awareness levels, this research aims to identify areas for improvement in patient education and support. The findings of this study will be instrumental in guiding future efforts to enhance perioperative care, ensuring that patients are well-prepared and informed, ultimately contributing to improved surgical outcomes and patient safety.

Objectives of the Study:

The primary objective of this study is to assess the level of awareness and knowledge regarding Pre Anesthetic Check Up among the patients coming for surgery at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Study duration- between January 2024 to May 2024

• Study population: The study's target population encompassed the patients coming for surgery at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Sample size- A robust sample size of 400 was determined using a 95% confidence level, an estimated knowledge level of 50% regarding intraopertive monitoring, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Pre Anesthetic Check Up was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Pre Anesthetic Check Up. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

  Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the patients coming for surgery at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

   

The study assessed 400 patients from Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh, focusing on their socio-demographic characteristics and knowledge of Pre Anesthetic Check Up (PAC).

This table-1 presents the socio-demographic characteristics of the study participants, which is crucial for understanding the background of the population under study. The majority of the participants (74%) were less than 40 years old, reflecting a relatively young cohort, which is typical in many medical settings where younger individuals might be more engaged in surgical procedures. Gender distribution showed a slight male predominance (55%), which aligns with general population demographics. Marital status indicated that most participants were married (55%), with 40% being single and a small percentage (5%) being divorced or widowed. Educational levels varied, with a significant proportion having at least secondary education (30%) or higher secondary education (25%), while a smaller group had no formal education (10%). This diverse educational background underscores the varying levels of health literacy that could impact awareness and knowledge of Pre Anesthetic Check Up (PAC).

                                                  Table 1: Socio-Demographic Characteristics of Participants (N = 400)

This table-2 provides insights into the awareness of PAC among participants. A significant portion of the participants (70%) had heard about PAC, indicating a basic level of awareness. However, deeper understanding seemed limited; only 60% knew the purpose of PAC, and 50% understood its components, highlighting a gap in comprehensive knowledge. Awareness about the importance of disclosing medical history was slightly better at 55%, but knowledge of preoperative fasting guidelines was notably low at 40%. These findings suggest that while basic awareness exists, there is a need for more detailed education on specific aspects of PAC to ensure patients are well-prepared for surgery.

                                                         Table 2: Awareness of Pre Anesthetic Check Up (PAC) (N = 400)

This table-3 categorizes the knowledge scores of participants into four distinct groups: Very Good, Good, Fair, and Poor. Only 20% of the participants fell into the Very Good category, demonstrating a strong understanding of PAC. Meanwhile, 30% had Good knowledge, 25% had Fair knowledge, and another 25% had Poor knowledge. This distribution reveals that a significant portion of the population has suboptimal knowledge regarding PAC. The need for enhanced educational efforts is evident to move more participants into the higher knowledge categories, ensuring they are better prepared and informed for their surgical procedures.

                                                     Table 3: Knowledge Scores on Pre Anesthetic Check Up (N = 400)

This table-4 identifies barriers to understanding PAC, providing crucial information for developing targeted interventions. The most significant barrier was the lack of information from healthcare providers, reported by 40% of the participants. This suggests that improving communication and education efforts within healthcare settings could significantly enhance understanding. Limited access to educational materials was the second major barrier (30%), highlighting the need for readily available and accessible informational resources. Additionally, 20% of participants cited low health literacy as a barrier, emphasizing the importance of tailoring educational strategies to different literacy levels. Lastly, language barriers affected 10% of participants, suggesting the need for multilingual resources to cater to the diverse population. Addressing these barriers is essential for improving overall awareness and knowledge of PAC among patients.

                                                            Table 4: Barriers to Understanding PAC (N = 400)

The present study aimed to assess the level of awareness and knowledge regarding Pre Anesthetic Check Up (PAC) among patients scheduled for surgery at Pt Jawahar Lal Nehru Government Medical College, Chamba, Himachal Pradesh. The findings provide crucial insights into the socio-demographic characteristics of the patients, their awareness and understanding of PAC, their overall knowledge levels, and the barriers they face in comprehending PAC. These results highlight significant gaps in patient education and suggest directions for future interventions to improve perioperative care quality.

The socio-demographic profile of the study participants reveals a relatively young cohort, with the majority (55%) being under 40 years of age. This is consistent with other studies that show a younger population often forms a significant portion of patients undergoing surgery. The gender distribution in our study showed a slight male predominance (55%), which aligns with the general population demographics reported in similar healthcare settings. The educational background of our participants varied, with a substantial portion having at least secondary education (30%) or higher secondary education (25%), which is crucial as higher education levels generally correlate with better health literacy. This diverse educational background underscores the varying levels of health literacy among patients, which can impact their awareness and knowledge of PAC.

The awareness levels of PAC among participants were moderately high, with 70% having heard about PAC. However, a deeper understanding of PAC was limited, with only 60% knowing its purpose and 50% understanding its components. This aligns with findings from previous studies, which reported that while many patients had heard of PAC, a comprehensive understanding was often lacking [11-13]. The awareness of the importance of disclosing medical history was slightly better at 55%, which is crucial as accurate medical histories are essential for safe anesthesia administration. Notably, only 40% of participants knew about preoperative fasting guidelines, highlighting a significant gap in patient education. Similar results were found in a earlier studies, which reported low awareness of preoperative fasting guidelines among surgical patients, emphasizing the need for targeted educational interventions. [14,15]

The distribution of knowledge scores among participants reveals a significant portion with suboptimal knowledge regarding PAC. Only 20% of participants fell into the Very Good category, while 30% had Good knowledge, 25% had Fair knowledge, and another 25% had Poor knowledge. These results are concerning and indicate the need for enhanced educational efforts. The findings suggest that more comprehensive and accessible educational programs are necessary to improve patient knowledge and preparedness for surgery. Ensuring that patients are well-informed about PAC can lead to better preoperative preparation, reduced anxiety, and improved surgical outcomes. [12-14]

The most significant barrier to understanding PAC identified in our study was the lack of information from healthcare providers, reported by 40% of participants. This is consistent with findings from a previous study, which highlighted insufficient communication as a major barrier to patient understanding of perioperative processes. Limited access to educational materials was another major barrier (30%), emphasizing the need for readily available and accessible informational resources. Additionally, 20% of participants cited low health literacy as a barrier, which aligns with the findings of a  previous study that emphasized the impact of health literacy on patients' ability to understand medical information. Lastly, language barriers affected 10% of participants, suggesting the need for multilingual resources to cater to the diverse population. Addressing these barriers is essential for improving overall awareness and knowledge of PAC among patients. [14-17]

Our findings are consistent with other studies that have explored patient awareness and knowledge of PAC. Additionally, our study's identification of barriers to understanding PAC aligns with the barriers reported in  previous studies, which also emphasized the need for improved patient education and accessible resources. These consistent findings across different studies highlight the widespread nature of the issue and the need for targeted interventions to enhance patient education. [15-18]

The insights gained from this study have significant implications for practice and policy at Pt Jawahar Lal Nehru Government Medical College and similar institutions. There is a clear need for interventions that promote better patient education regarding PAC. These could include ensuring the availability of accessible educational materials, scheduling regular preoperative counseling sessions, and conducting educational campaigns to raise awareness about the importance of PAC. Implementing these measures can help mitigate the barriers identified and improve the overall understanding and preparedness of patients for surgery.

Limitations

This study has several limitations that should be acknowledged. Firstly, the reliance on self-reported data may introduce response bias, as participants might overestimate or underestimate their knowledge and awareness of Pre Anesthetic Check Up (PAC). Secondly, the cross-sectional design limits the ability to infer causality between knowledge levels and perioperative outcomes. Longitudinal studies would be more effective in establishing causal relationships. Additionally, the study was conducted at a single institution, which may limit the generalizability of the findings to other settings with different demographic and geographic characteristics. Moreover, the use of online questionnaires could exclude individuals with limited access to or proficiency with digital platforms, potentially skewing the sample. Finally, the questionnaire's pre-testing on a small sample might not have captured all possible comprehension issues, which could affect the accuracy of responses.

In conclusion, this study has provided valuable insights into the level of awareness and knowledge regarding Pre Anesthetic Check Up among patients at Pt Jawahar Lal Nehru Government Medical College, Chamba, Himachal Pradesh. The findings highlight significant gaps in patient education, with many patients demonstrating suboptimal knowledge of PAC and its importance. Key barriers to understanding PAC include insufficient information from healthcare providers, limited access to educational materials, low health literacy, and language barriers. These results emphasize the need for targeted interventions to improve patient education and communication about PAC. By addressing these gaps and promoting better education strategies, healthcare providers can enhance patient preparedness and contribute to improved perioperative care and surgical outcomes. Future research should continue to explore and evaluate effective strategies to ensure patients are well-informed and prepared for surgery, ultimately leading to better health outcomes and patient satisfaction.

Funding: No funding sources.

Conflict of interest: None declared.

1. Singla, Deepak, and Mishu Mangla. "Patient's knowledge and perception of preanesthesia check-up in rural India." Anesthesia Essays and Researches 9.3 (2015): 331-336. DOI: 10.4103/0259-1162.158008

2. Asthana, Unnati, and Shruti Sharma. "An assessment of the patient’s understanding and knowledge of the relevance of pre-anesthetic check-up." Panacea Journal of Medical Sciences 13.1 (2023): 82-87.https://doi.org/10.18231/j.pjms.2023.018 

3. Zambouri, A. "Preoperative evaluation and preparation for anesthesia and surgery." Hippokratia 11.1 (2007): 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464262/ 

4. Omole, Olufemi B., Michelle Torlutter, and Agetta J. Akii. "Preanaesthetic assessment and management in the context of the district hospital." South African Family Practice 63.3 (2021).https://orcid.org/0000-0002-8071-8607 

5. Shevde, Ketan, and Georgia Panagopoulos. "A survey of 800 patients' knowledge, attitudes, and concerns regarding anesthesia." Anesthesia & Analgesia 73.2 (1991): 190-198.https://journals.lww.com/anesthesia-analgesia/abstract/1991/08000/A_Survey_of_800_Patients__Knowledge,_Attitudes,.13.aspx 

6. Baaj, Jumana, et al. "Saudi patients' knowledge and attitude toward anesthesia and anesthesiologists--A prospective cross-sectional interview questionnaire." Middle East journal of anaesthesiology 18.4 (2006): 679-691. https://europepmc.org/article/med/16749563?utm_medium=email&utm_source=transaction&client=bot&client=bot&client=bot&client=bot 

7. Hofer, C. K., et al. "Patients’ needs and expectations regarding anaesthesia: A survey on the pre-anaesthetic visit of patients and anaesthesiologists." Der Anaesthesist 53 (2004): 1061-1068.https://doi.org/10.1007/s00101-004-0763-4

8. Ahsan-Ul-Haq, M., Waqar Azim, and M. Mubeen. "A survey of patients' awareness about the peri-operative role of anaesthetists." Biomedica 20.1 (2004): 5-9. http://www.thebiomedicapk.com/articles/4.pdf 

9. Hariharan, Seetharaman. "Knowledge and attitudes of patients towards anes-thesia and anesthesiologists. A review." Anestesia en Mexico 21 (2009): 174-8.

10. Gurunathan, Usha, and Rebecca Jacob. "The public's perception of anaesthesiologists-Indian attitudes." Indian J Anaesth 48.15 (2004): 40-6.

11. Mathur, S. K., S. K. Dube, and Sunil Jain. "Knowledge about anaesthesia and anaesthesiologist amongst general population in India." Indian journal of anaesthesia 53.2 (2009): 179-186.https://journals.lww.com/ijaweb/fulltext/2009/53020/knowledge_about_anaesthesia_and_anaesthesiologist.8.aspx 

12. Azab, A. E., et al. "Evaluate Patient’s Awareness Regarding Significance of Pre-Anesthetic Checkup for Elective Surgery in Western Libya." Archives of Anesthesia, vol. 3, no. 1, (2020), pp. 1–9.
13. Sagün, Aslinur, Handan Birbiçer, and Gulcin Yapici. "Patients’, who applied to the anesthesia clinic, perceptions and knowledge about anesthesia in Türkiye." Saudi Journal of anaesthesia 7.2 (2013): 170-174. DOI: 10.4103/1658-354X.114076

14. Forrest, James B., et al. "Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes." Anesthesiology 76.1 (1992): 3-15. https://doi.org/10.1097/00000542-199201000-00002 

15. Eyelade, Olayinka Ramat, J. O. Akinyemi, and I. F. Adewole. "Patients' perception and knowledge of anaesthesia and anaesthetists-a questionnaire survey." Southern African Journal of Anaesthesia and Analgesia 16.4 (2010): 28-31. https://hdl.handle.net/10520/EJC73788 

16. Bhattarai, B., S. Kandel, and N. Adhikari. "Perception about the role of anesthesia and anesthesiologist among the paramedical staffs: Perspective from a medical college in Nepal." Kathmandu Univ Med J (KUMJ) 10.2 (2012): 51-4. https://www.academia.edu/download/96969162/5957.pdf 

17. ShEtty, LAtA D., and KAILASH VEERAREDDY REDDY. "Awareness of the Role of Anaesthetists and Importance of Preanaesthetic Check-up among Patients: A Cross-sectional Study." Journal of Clinical & Diagnostic Research 16.9 (2022). 10.7860/JCDR/2022/55846.16816

18. Kristoffersen, Eirunn Wallevik, et al. "Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies." BMJ open 12.5 (2022): e054206. https://doi.org/10.1136/bmjopen-2021-054206