Anesthesiology as a specialty is evolving out of the operating room because of the changing health environment of managed care. Our specialty is now involved in the intensive care unit, pain clinic, postanesthesia care unit, and preoperative clinic. Because of the emphasis on cost-containment, the concept of anesthesiologists as the “perioperative physicians” has expanded owing to our ability to follow the patient through each phase of the preoperative, intraoperative, and postoperative period.

In 1947, Dr. Lee proposed that an anesthetic outpatient department could contribute considerably to preventive medicine.<sup>32 Lee J. The anesthetic outpatient clinic Anaesthesia 1949 ;  4 : 169-174

Cliccare qui per andare alla sezione Riferimenti</sup> He suggested that the department be staffed by members of the anesthesia department and that the benefits would include increased patient care as well as increasing personal contact between anesthesiologist and patient. Unfortunately, the idea did not gain popularity because preoperative evaluations could be done easily by seeing the patient the night before surgery in the hospital ward. By the 1990s, outpatient surgery had grown owing to economic factors. The benefits of contacting the patient prior to his/her arrival in the holding area had been clearly demonstrated.<sup>47 Roizen M., Kaplan E., BD S. The relative roles of the history and physical examination and laboratory testing in preoperative evaluation for outpatient surgery: The “Starling” curve of preoperative laboratory testing Anesth Clin North Am 1987 ;  5 : 15-34

Cliccare qui per andare alla sezione Riferimenti</sup> Because of this shift, many hospitals have responded to the demand for efficient, cost-saving, high-quality health care for surgical patients with the creation of preoperative clinics and perioperative programs. The clinics focus on all aspects of preparation of the patient for surgery including medical, nursing, and administrative procedures. The primary goal is to streamline this process and facilitate movement of the patient through anesthesia and surgery. Their role is to encompass a broader scope of patient management from admission through discharge. Initial reports suggest a high acceptance among patients, with improved patient care, increased efficiency, and cost savings.<sup>26 Kerridge R., Lee A., Beehan S. , e al. The perioperative system: A new approach to managing elective surgery Anaesth Intensive Care 1995 ;  23 : 591-596

Cliccare qui per andare alla sezione Riferimenti, 46 Pollard J.B., Zboray A.L., Mazze R.I. Economic benefits attributed to opening a preoperative evaluation clinic for outpatients Anesth Analg 1996 ;  83 : 407-410  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In this article, we will evaluate preoperative programs in terms of organization, staffing, and cost efficiency; discuss preoperative evaluations and who should do them; and present several models of clinics that have been developed.