Influence of an anaesthetist on nurse‐led, computer‐based, pre‐operative assessment

Barnes, P.K.; Emerson, Peter A.; Hajnal, S.; Radford, W. J. P.; Congleton, Jo

doi:10.1046/j.1365-2044.2000.01377.x

Cited by 29 publications

(15 citation statements)

References 6 publications

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“…Outpatients operated in general OR or ambulatory surgical center have the same case cancellation rate although the reasons for cancellation were different. The outpatient case cancellation rate is within the range reported in settings in which a preoperative clinic exists (from 1.8% to 8.4%) [5,10]. Same day admission has the lowest cancellation rate at 2.0%.…”

Section: Case Cancellation Ratesupporting

confidence: 60%

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Xue

Yan

Barnett

et al. 2013

J Anesthe Clinic Res

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Background: Unexpected surgical cancellation is common and can have significant adverse effects. Cancellation rates vary because of a lack of a standard definition, different patient populations and study methodology. We hypothesized that case cancellation has a different pattern in a dedicated ambulatory surgical center compared to a general operating room (OR) setting in a large academic center without an anesthesia preoperative evaluation center necessitating evaluation by the various surgeons.Methods: Elective cases in general OR and in the ambulatory surgical center were included in this study. Elective cases are defined as the non-emergent cases scheduled before 8:00 am on the day of surgery. A cancelled case was defined as a scheduled procedure which is not performed on the scheduled procedure day. Case cancellation was monitored in real time using an electronic patient flow system (Navicare). As soon as the case is cancelled, the reason for the cancellation was obtained from the surgeon, the anesthesiologist, the OR coordinated nurses and/or the floor nurse. In the day surgical center, the cancelled cases were followed to determine whether/when they were rescheduled.Results: 4261 elective cases were included in this investigation, including 2751 cases in the general OR and 1510 cases in the ambulatory surgical center. A total of 283 cases (6.6%) were cancelled which include 206 cases from the general OR and 77 from the ambulatory surgical center. The cancellation rate in the general OR was 7.5%, among which inpatients have the highest cancellation rate of 18.1%, followed by outpatients at 4.6%, and same day admission at the lowest cancellation rate of 2.0%.The top 3 reasons for cancellation in general OR werein adequate preoperative preparation 29.4 ± 4.5%, medical condition change 28.5 ± 10.2%; and scheduling issue 20.2 ± 7.1%. Most (59.2 ± 8.9%) of the cancellations was considered preventable, 12.3 ± 5.9% was considered potentially preventable, and 28.5 ± 10.2% were not preventable (such as patient condition changes). The cancellation rate in the ambulatory surgical center was 5.1%. The major reason for cancellation was patient no show 75.8 ± 5.2 %, 61% of those no show patients were rescheduled and the mean delay in surgery was 18 days (range from 1 day to 84 days). Conclusions:Case cancellation is not un-common in a large academic center without a preoperative evaluation clinic. The dynamics of case cancellation are different in an ambulatory surgical center as compared to the general OR. Inpatients have the highest cancellation rate associated with inadequate preoperative preparation and scheduling, this should be preventable via adopting proper systems of evaluation and preparation. Most of the case cancellations in the ambulatory surgical center are from patient no show, suggesting that administrative strategies to reduce this issue should be implemented. The patients admitted on the same day of surgery had the lowest cancellation rate requiring minimal intervention.

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Section: Case Cancellation Ratesupporting

confidence: 60%

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Xue

Yan

Barnett

et al. 2013

J Anesthe Clinic Res

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“…A number of recent publications have suggested that pre‐operative assessment of patients some weeks before surgery can potentially reduce cancellation of operations on the day of surgery [1–5]. It has also been suggested that trained nurses can undertake many aspects of the pre‐operative assessment, with overall supervision by a consultant anaesthetist [6,7]. Recently, Barnes et al.…”

mentioning

confidence: 99%

Day of surgery cancellations after nurse‐led pre‐assessment in an elective surgical centre: the first 2 years

2003

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SummaryFactors affecting the spread of bupivacaine in the paravertebral space were investigated in patients undergoing paravertebral nerve blocks for the treatment of chronically painful conditions. Injections of bupivacaine 0.5%, 10-15 ml mixed with depomedrone up to 80 mg were repeated at 2-wk intervals up to a maximum of four times. A blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5-min intervals after each injection. Age, sex, height and weight did not correlate with the block; nor did injectate volume, mass of bupivacaine, previous posterolateral thoractomy and spread of radiocontrast. Injections repeated at 2-wk intervals in the same patient resulted in different degrees of spread that were unrelated to one another. Time to peak onset of blockade was 40 min in 95% of patients. A single bolus of bupivacaine produces a safe but unpredictable block. Yet to be defined physical properties and anatomical factors are probably key determinants of the spread of bupivacaine in the paravertebral space. This single bolus technique may be better supplanted by a reversion to the older multiple level injection technique.Keywords Local anaesthetic. Bupivacaine: nerve block, intercostal nerve. Two aspects of paravertebral nerve blocks that have been poorly investigated are the predictability of spread of local anaesthetic and the reliability of production of the block. To identify any involved factors, we undertook this prospective, single-blinded, longitudinal, observational study of patients undergoing therapeutic paravertebral blocks as a part of their chronic pain management. MethodsThe study was approved by the local ethics committee and written informed consent was obtained from all patients.Patients listed for therapeutic paravertebral injections as a component of management of chronically painful conditions of the chest and abdomen were included in the study. Those with a pre-existing sensory deficit were excluded. A single injection technique was used, as described elsewhere [1]. All blocks were performed to the satisfaction of the same experienced operator (J.R.). Correct Tuohy needle placement alongside the vertebral column superior to the transverse process in each patient was confirmed through the injection of 3 ml of radioopaque dye (Isovist, Schering, Germany). All material was injected with the Tuohy needle opening pointing cranially and contrast medium was tracked with an image intensifier, its shape being categorised as globular or as a cranio-caudal streak. Bupivacaine 0.5%, 10-15 ml mixed with depomedrone up to 80 mg was injected over 60 s.In the recovery room, a blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5-min intervals until a stable block had been established, i.e. two 5-min observations were the 684Ó 2003 Blackwell Publishing Ltd same. The cold stimulus used was a mixture of ice in tap water contained in a copper test tube. Each patient also had non-invasive measurements...

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“…It has been repeatedly stated that capnography saves lives, most recently in the 4th National Audit Project [2], and it is included in guidelines by both the Association of Anaesthetists [3] .............................................................................................................................................................................................................. We started auditing the transfer of our patients from the Emergency Department after intubation, looking at both the indications for transfer and the monitoring used. At the end of each shift, the on-call anaesthetic registrar was contacted and asked to provide details of any transfers that had occurred.…”

Section: Transfer Of the Critically Ill In Walesmentioning

confidence: 99%

Critical care transfers: using audit to make a difference

Shonfeld¹,

Riyat²,

Kotecha³

et al. 2011

Anaesthesia

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Influence of an anaesthetist on nurse‐led, computer‐based, pre‐operative assessment

Cited by 29 publications

References 6 publications

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Day of surgery cancellations after nurse‐led pre‐assessment in an elective surgical centre: the first 2 years

Critical care transfers: using audit to make a difference

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