An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic

Abstract

Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment clinic. The data set were split into derivation and validation cohorts. Standard multiple regressions were used to construct a model in the derivation cohort, which was then tested in the validation cohort. Due to missing data, 2457 patients were not studied, leaving 5892 for analysis (3870 in the derivation cohort and 2022 in the validation cohort). The mean (SD) pre-operative assessment time was 46 (12) min. Age, ASA physical status, nurse practitioner and surgical specialty all influenced the time spent in preoperative assessment. The predictive equations calculated using the derivation cohort, based on age and ASA physical status, correctly estimated duration of consultation to within 20% of the maximum predicted time in 74.2% of the validation cohort. We conclude that if age and ASA physical status are known before the pre-operative assessment consultation, it could allow appointment times to be allocated more accurately.

Surgery cancellations after entering the operating room

“…In particular, the preoperative examinations planned by the attending surgeon should be checked, and vital signs at the ward should be confirmed by ward staff. A double-checking system could also be implemented, involving a nurse checking the essential preoperative examinations before the anesthesiologist does [9]. Requests for medical devices, such as a pacemaker, should be confirmed the day prior to surgery; not doing so constitutes a lack of communication.…”

Pre-operative testing guidelines: a NICE try but not enough

“…The NICE guideline stratifies the surgical complexity into minor, intermediate or major/complex, but, beyond a limited number of examples, does not provide a reference source for this classification. Many pre‐operative clinics may choose to use the Clinical Coding and Schedule Development (CCSD) Group resource, especially as pre‐operative assessment is now increasingly led by nurse practitioners or by patient self‐completion using electronic programs . This could result in difficulties in accurately classifying the magnitude of the surgery for an individual patient and may lead to procedures such as laparoscopic cholecystectomy, anterior cruciate ligament repair and lumbar microdiscectomy being classified as major procedures.…”

Hypertension: is it a peri‐operative or a public health problem?

“…This places substantial pressure on the primary care consultation (which lasts on average approximately 11 minutes ), particularly if other aspects of ‘fit for referral’ also need consideration. Conversely, within our institution, a full pre‐operative assessment appointment allows patients on average 50 minutes face‐to‐face contact with trained nursing staff . Patients who attend often view this as a global health check‐up and, with this luxury of time, we would argue that pre‐operative assessment is an ideal opportunity to ensure accurate, repeated blood pressure measurements, taken according to national guidance, and delivered alongside other important health screening interventions such as informing patients of their BMI and offering referral for smoking cessation.…”