Pre‐operative screening: Criteria for referring to anaesthetists

Abstract

SummaryNurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.Keywords Anaesthesia; pre-operative, assessment. The National Booked Admissions programme was launched in 1998 in the UK as part of the government's strategy for modernising the National Health Service (NHS). The booking system includes booking from general practice to outpatient clinics, or day-case surgery, and booking from within hospitals for day-case and inpatient admissions. During one visit to hospital, patients will be seen by the consultant and pre-assessed for treatment if necessary [1,2]. The NHS Modernisation Agency, through the National Pre-operative Assessment Project, continues to develop pre-operative assessment by nurses [3]. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommends the provision of pre-operative screening [4] by a team led by an appropriately trained nurse in a pre-operative assessment clinic.Typically, nurses assess patients using a screening questionnaire, usually developed in conjunction with anaesthetists. ÔAnything out of the ordinaryÕ is referred to an anaesthetist for further evaluation, before the day of surgery [5,6]. The most valuable questions to ask to identify anything out of the ordinary are not yet clear.Our objective was to determine, using consensus methods, which questions used in pre-operative assessment questionnaires might identify patients who should be seen by an anaesthetist before the day of surgery.This information could facilitate standardisation of preoperative assessment which could be incorporated into the booked admissions system, and lead to a more reliable method of referral to an anaesthetist. MethodFlow diagrams summarising methods are shown in Figs 1 and 2.We collected a list of questions frequently used in preoperative assessment questionnaires from published literature and local day surgery protocols. We searched Medline from 1981 to 2001, using the MeSH terms: ÔanaesthesiaÕ, Ôpre-operative evaluationÕ, Ôassess...

Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests

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Nursing knowledge and the expansion of day surgery in the United Kingdom

“…However, much of this work is dominated by medical protocols in order to guarantee medical fitness for surgery (22)(23)(24)(25)(26) . Although such tasks are vital, an unfortunate consequence of such a rapidly changing medical agenda is that evidence based 'nursing knowledge' has contributed very little to the success of day surgery (27) .…”

“…However, extended roles and the gaining of pre-assessment skills both embrace devolved medical tasks (23,26,38,(61)(62)(63)(64)(65) . Unfortunately, the exposition of nursing knowledge is again not considered although some studies have demonstrated the value of nursing skills in the pre-assessment clinic (39,66) .…”

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“…Pre-anesthetic screening questionnaires given by nurses have proven useful in helping to streamline communications between nursing and anesthesia personnel. 12,13 The cooperation of anesthesia colleagues, surgeons, and nurses has been recognized as essential for the proper implementation of fasting guidelines published by the American Society of Anesthesiologists. 14 Patients should not be under "nothing by mouth" (NPO) orders for extended periods of time and may have clear liquids up to 2 to 4 hours preprocedure to maintain their fluid status.…”