Nurse-led Preoperative Assessment Research Articles

Effectiveness of Nurse-Led Preoperative Assessment for Anesthesia: A Prospective Cohort Study

PurposeThis study aimed to evaluate, in low-complexity surgical patients, the effectiveness of preoperative assessment carried out by nurses with formal postgraduate anesthetic training compared to that carried out by anesthesiologists in terms of cancellations and inadequate surgical preparation. DesignThis experimental research was conducted using a prospective cohort study. MethodsOne hundred and eighty-three patients were recruited who had undergone low-complexity surgery between May and September 2020. Sixty-nine patients were preoperatively assessed by a nurse with specific 1-year postgraduate university training in anesthesia and 114 by an anesthesiologist. Data collection included a questionnaire to assess patient satisfaction and knowledge acquired from the preoperative assessment. FindingsCancellations of surgery were the same in both cohorts (3.8%, 2.6%). The incidence of poor preparation attributable to the patient was also similar in both cohorts (17.0% vs 18.4%). Patients seen by nurses valued the satisfaction with the preoperative assessment more highly than patients seen by anesthesiologists (median 91.67 vs 84.62). In terms of Knowledge obtained from the preoperative assessment, both professionals did not show statistically significant differences in knowledge levels. ConclusionsPreoperative patient assessment performed by a nurse, with formal anesthesia training, in low-complexity surgical patients can be as effective as that performed by an anesthesiologist, without having an impact on surgical cancellations or patient preparation. On the day of surgery, patients who had been assessed by a nurse were more satisfied with their care during the visit and acquired similar knowledge about preoperative preparation as patients assessed by anesthesiologists.

A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction.

ObjectiveStandard pre-operative assessment at our institution involves a comprehensive history and examination by a nurse practitioner. An electronic pre-operative assessment questionnaire, ePAQ-PO® (ePAQ, Sheffield, UK) has previously been developed and validated. This study aimed to determine the impact of ePAQ-PO on nurse consultation times and patient satisfaction in low-risk patients.MethodsThe duration of pre-operative assessment consultation was recorded for American Society of Anesthesiology physical classification 1 and 2 patients undergoing pre-operative assessment by an electronic questionnaire (ePAQ-PO group) and standard face-to-face assessment by a nurse practitioner (standard group). Patients were also asked to complete an eight-item satisfaction questionnaire. Eighty-six patients were included (43 in each group).ResultsAfter adjusting for the duration of physical examination, median (IQR [min-max]) consultation time was longer in the standard compared to the ePAQ-PO group (25 (18–33 [10–49]) min vs. 12 (8–17 [4–45]) min, respectively; p <0.001). Response rate for the satisfaction questionnaire was 93%. There was no significant difference in patient satisfaction scores (38/39 in standard group vs. 39/41 in ePAQ-PO group were fully satisfied with their pre-operative assessment; p = 0.494).ConclusionPre-operative assessment using ePAQ-PO is associated with a significant reduction of over 50% in the duration of the assessment without impacting on patient satisfaction.

Preoperative assessment clinic in interventional radiology. Provision of high-quality service and improving patient experience

Background to the audit: The Royal College of Radiologists (RCR) highlights the importance of nurse-led preoperative assessment clinics to assess patient suitability for treatment, optimise patient preparation and improve patient experiences1.

The Effectiveness of Nurse-Led Preoperative Assessment Clinics for Patients Receiving Elective Orthopaedic Surgery: A Systematic Review

Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care. The Joanna Briggs Institute (JBI) approach for conducting systematicreview of quantitative research was used. Data bases searched included all published and unpublished studies in Chinese and English. All studies with adult patients who required elective orthopaedic surgery e.g. total knee replacement, total hip replacement, reduction of fracture or reconstruction surgery etc. in a hospital or day surgery center and attended a nurse-led POAC before surgery were included. Ten studies were critically appraised. Results showed that nurse-led POACs can reduce surgery cancellation rates. These studies suggested a reduction in the rate of postoperative mortality and length of hospital stay. In addition, the level of satisfaction towards services provided was significantly high. Although POACs are being increasingly implemented worldwide, the development of clinical guidelines, pathways and protocols was advocated. The best available evidence asserted that nurses in the POAC could serve as effective coordinators, assessors and educators. The nurse-led practice optimized patients' condition before surgery and hence minimized elective surgery cancellations.

Effectiveness of an Advanced Practice Nurse-Led Preoperative Telephone Assessment.

The purpose of this project was to determine the effectiveness of an advanced practice nurse-led preoperative telephone assessment in reducing day-of-surgery cancellations of patients at an ambulatory surgery center. We concluded that a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations. Patients who were identified at high risk for preoperative complications during the telephone assessment were referred to the preoperative evaluation clinic for further evaluation.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update.

Nurse-led preadmission clinics or services have been implemented in many health services as a strategy to facilitate the admission and assessment of booked surgical cases. In order to provide the most recent available evidence, this systematic review is an update of our previous review published in 2010. The objective of this review was to integrate recent research with a previously published systematic review on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. The review considered studies that included adult or pediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient. The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and patient or parent satisfaction. TYPES OF STUDIES: The review update considered any randomized controlled trials published after 2009; in the absence of randomized controlled trials other research designs, such as non-randomized controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in each component of this review. Methodological validity was assessed by two reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Due to the clinical heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. Four new studies were identified from searches and added to the 19 studies from the previous review for a total of 23 studies. There is weak evidence to suggest nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, length of stay, adverse surgical events and morbidity. Similarly weak evidence suggests nurse-led preadmission services may improve patient preparation, recognition of postoperative needs and patient/parent satisfaction. While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update

Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia

The organization of elective surgical services has changed in recent years, with increasing use of day surgery, reduced hospital stay and preoperative assessment (POA) performed in an outpatient clinic rather than by a doctor in a hospital ward after admission. Nurse specialists often lead these clinic-based POA services and have responsibility for assessing a patient's fitness for anaesthesia and surgery and organizing any necessary investigations or referrals. These changes offer many potential benefits for patients, but it is important to demonstrate that standards of patient care are maintained as nurses take on these responsibilities. We wished to examine whether a nurse-led service rather than a doctor-led service affects the quality and outcome of preoperative assessment (POA) for elective surgical participants of all ages requiring regional or general anaesthesia. We considered the evidence that POA led by nurses is equivalent to that led by doctors for the following outcomes: cancellation of the operation for clinical reasons; cancellation of the operation by the participant; participant satisfaction with the POA; gain in participant knowledge or information; perioperative complications within 28 days of surgery, including mortality; and costs of POA. We planned to investigate whether there are differences in quality and outcome depending on the age of the participant, the training of staff or the type of surgery or anaesthesia provided. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and two trial registers on 13 February 2013, and performed reference checking and citation searching to identify additional studies. We included randomized controlled trials (RCTs) of participants (adults or children) scheduled for elective surgery requiring general, spinal or epidural anaesthesia that compared POA, including assessment of physical status and anaesthetic risk, undertaken or led by nursing staff with that undertaken or led by doctors. This assessment could have taken place in any setting, such as on a ward or in a clinic. We included studies in which the comparison assessment had taken place in a different setting. Because of the variation in service provision, we included two separate comparison groups: specialist doctors, such as anaesthetists; and non-specialist doctors, such as interns. We used standard methodological approaches as expected by The Cochrane Collaboration, including independent review of titles, data extraction and risk of bias assessment by two review authors. We identified two eligible studies, both comparing nurse-led POA with POA led by non-specialist doctors, with a total of 2469 participants. One study was randomized and the other quasi-randomized. Blinding of staff and participants to allocation was not possible. In both studies, all participants were additionally assessed by a specialist doctor (anaesthetist in training), who acted as the reference standard. In neither study did participants proceed from assessment by nurse or junior doctor to surgery. Neither study reported on cancellations of surgery, gain in participant information or knowledge or perioperative complications. Reported outcomes focused on the accuracy of the assessment. One study undertook qualitative assessment of participant satisfaction with the two forms of POA in a small number of non-randomly selected participants (42 participant interviews), and both groups of participants expressed high levels of satisfaction with the care received. This study also examined economic modelling of costs of the POA as performed by the nurse and by the non-specialist doctor based on the completeness of the assessment as noted in the study and found no difference in cost. Currently, no evidence is available from RCTs to allow assessment of whether nurse-led POA leads to an increase or a decrease in cancellations or perioperative complications or in knowledge or satisfaction among surgical participants. One study, which was set in the UK, reported equivalent costs from economic models. Nurse-led POA is now widespread, and it is not clear whether future RCTs of this POA strategy are feasible. A diagnostic test accuracy review may provide useful information.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update protocol

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update protocol

Anaesthetic training: not better, not worse, just different

Anaesthetic training: not better, not worse, just different

Identifying and reducing the incidence of post discharge Venous Thromboembolism (VTE) in orthopaedic patients: a systematic review.

BACKGROUND: The risk of venous thromboembolism for orthopaedic patients is often high due to the length of surgery, damage from trauma to bone and soft tissues and lengthy periods of immobility or reduced mobility. Although venous thromboembolism occurs mainly in inpatients a significant number of patients develop venous thromboembolism post discharge OBJECTIVES: To synthesise the best available evidence on strategies that effectively reduce post discharge venous thromboembolism in orthopaedic patients. INCLUSION CRITERIA: Patients regardless of age, gender or co-morbidities that have been admitted with an acute orthopaedic injury (unplanned) or a planned orthopaedic surgery/procedure and then followed up after discharge. Only papers describing the incidence and prophylaxis treatment used in non-Asian patients were considered for inclusion. Any interventions of combinations of chemoprophylaxis and/or mechanical prophylaxis to prevent venous thromboembolism incidence extending beyond hospital admission. Outcomes included diagnosis of venous thromboembolism following an orthopaedic admission/surgery for up to 6 months post discharge and the incidence of any significant bleeding or death related to venous thromboembolism or haemorrhage.The review considered any randomised controlled trials; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered SEARCH STRATEGY: Search strategy considered only papers in English from 2000 to March 2012. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION: Data was extracted from the studies using the standardised Johanna Briggs Institute data extraction form. DATA SYNTHESIS: Of the included studies none matched methodology, treatment or comparator that allowed meta-analysis. The results were therefore presented in a narrative form and were structured using patient population, then intervention and then analysis of results. RESULTS: 20 articles were included in the systematic review. The overall incidence of post discharge venous thromboembolism in orthopaedic patients is not possible to determine due to the variability in reporting criteria and poor follow-up. Use of Low Molecular Weight Heparins was generally shown to be effective in preventing venous thromboembolism. The new generation Factor Xa inhibitors were shown to improve venous thromboembolism prevention however had a slightly higher risk of bleeding. There was limited high level research presented to allow effective assessment of aspirin and/or mechanical compression devices. CONCLUSIONS: Prevention of post discharge venous thromboembolism is complex due to the number of variables that can influence its occurrence. The risk of post discharge venous thromboembolism varies among different patient populations so consideration must be given to matching the risk for each of those groups with available interventions.For higher risk orthopaedic patient groups such as those with large joint replacements and femoral fractures low molecular weight heparins should be considered and continued where possible post discharge for thirty days however the risk profile for venous thromboembolism and bleeding must be considered for both populations and individuals.Consideration in future research design must be given to factors such as: adequate follow-up time, and standardised criteria to measure the incidence of post discharge venous thromboembolism. • Save items Add to Favorites View more options Similar articles Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review. [JBI Libr Syst Rev. 2010] The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review. [JBI Libr Syst Rev. 2009] Review The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review. [JBI Database System Rev Implem...] Continuous Subcutaneous Insulin Infusion (CSII) Pumps for Type 1 and Type 2 Adult Diabetic Populations: An Evidence-Based Analysis. [Ont Health Technol Assess Ser....] Review The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review. [JBI Database System Rev Implem...] See reviews... See all... Cited by 1 PubMed Central article A systematic scoping review on the consequences of stress-related hyperglycaemia. [PLoS One. 2018] Related information Cited in PMC Search details 27820532[uid] Search See more... Recent Activity ClearTurn Off Effectiveness of tight glycemic control in the medical Intensive Care Unit: a sy... PubMed 27820532[uid] (1) PubMed 27820349[uid] (1) PubMed Effectiveness of Tight Glycemic Control in the Medical Intensive Care Unit: A Sy... PubMed

The effectiveness of nurse-led pre-operative assessment clinics for patients receiving elective orthopaedic surgery: a systematic review

Review objectives The specific review objectives are: To synthesize the evidence on the impact of nurse-led pre-operative assessment clinic for elective orthopaedic patients on health service outcomes, including cancellation or delay of surgery, length of hospital stay and waiting time for pre-operative assessment and surgery. To examine the effectiveness of nurse-led pre-operative assessment clinic on orthopaedic patient outcomes such as levels of satisfaction with the process of pre-operative assessment, incidence of post-operative complications, post-operative recovery, as well as levels of fear and anxiety before surgery. Inclusion criteria Types of participants: This review will consider all studies that included adult patients who were 18 years old or above, required elective orthopaedic surgeries e.g. total knee replacement, total hip replacement, reduction of fracture or procedure of arthroscopy etc in hospitals or day surgery centers, and had attended a nurse-led POAC. Adult elective orthopaedic surgical patients within the American Society of Anesthesiologist (ASA) Physical Status Classification of 1 or 2 will be eligible for inclusion in the review. ASA classification 1 patients are considered to be healthy and normal, and ASA classification 2 patients are patients with mild systemic disease such as mild asthma, well-controlled hypertension, or well-controlled diabetes. Studies will be excluded: - if the participants had received emergency orthropaedic surgery. - if they were primitively related to preoperative teaching or education. Types of interventions: The review will consider studies that evaluate the effectiveness of attending a nurse-led POAC for elective orthopaedic surgery. A POAC is defined as a clinic that provides a general medical and anaesthetic pre-operative assessment includes history taking, health assessment and physical examination. Routine investigations such as laboratory and blood tests may be carried out. Referral to specialists before surgery work-up and health education will also be provided. Patients would attend a POAC 2 to 4 weeks prior to the scheduled elective orthopaedic surgery. The nurse-led POAC could be solely run by nurses, or nurses worked collaboratively with physicians.TRUNCATED AT 350 WORDS

The effectiveness of nurse-led pre-operative assessment clinics for patients receiving elective orthopaedic surgery: a systematic review

The effectiveness of nurse-led pre-operative assessment clinics for patients receiving elective orthopaedic surgery: a systematic review

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review.

The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. Types of participants The review considered studies that included adult or paediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient.Types of interventions The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic.Types of outcomes This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and reducing the number of overnight stays for day or ambulatory surgery patients.Types of studies The review considered any randomised controlled trials published after 1999; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. This review excluded studies of preoperative education as this has been the subject of a previous review. We also excluded studies of emergency admissions. Additionally, studies comparing nurse-led with physician-led preadmission assessments were excluded as that has also been the subject of a previous systematic review. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilised in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. Papers selected for retrieval were assessed by two independent reviewers for congruence to the review's inclusion criteria, using a tool developed for the purpose. Methodological validity was assessed by two reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI. Due to the methodological heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service. While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed. Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low. Currently the overall level of evidence regarding nurse-led preadmission services is low and further more rigorous studies are required for all the examined outcomes. There is little evidence regarding the effect of this intervention on length of stay, mortality rates and morbidity, and therefore more research is needed on the effect of nurse-led preadmission services on these important outcomes.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review

The emergence of specialist orthopaedic nurses and nurse-led pre-operative assessment in the 1990s

Summary The article considers the development of orthopaedic nursing roles in the United Kingdom in the 1990s. The nurse practitioner role within pre-operative assessment clinics and other roles related to patient care after joint replacement surgery or trauma are described. Such roles developed because of changes in healthcare and legislation which allowed nurses to take on roles and responsibilities traditionally the preserve of other professions for the benefit of patient care.

The provision of information for patients prior to cataract surgery

This clinical audit evaluates the provision of patient information. It also establishes patients' views on satisfaction regarding the information provided at nurse-led preoperative assessment prior to giving informed consent for cataract surgery. A quantitative descriptive audit was conducted using a questionnaire, by which the questions reflected the baseline standards. A convenience sample of 75 postcataract patients took part in this retrospective audit. All 75 patients stated that they were either 'very satisfied' or 'satisfied' with both the verbal explanation and written information received, and identified the preoperative assessment nurse as the main source of information.

Effectiveness of nurse-led preoperative assessment services

Effectiveness of nurse-led preoperative assessment services

Effectiveness of nurse-led preoperative assessment services

Review Objective The objective is to review the available research on the effectiveness of nurse-led preoperative assessment clinics or services on patient outcomes. More specifically, the objectives are to identify: the effectiveness of nurse-led preoperative assessment services on reducing adverse surgical events, improving patient satisfaction, decreasing anxiety, reducing inpatient days and reducing the number of overnight stays for day or ambulatory surgery patients. Inclusion Criteria Types of Participants The review will consider studies that include adult or paediatric patients who are having any type of surgical procedure, either as a day-only case or as an inpatient. Types of Intervention The review will consider studies that evaluate the effect of attending or receiving the services of a nurse-led outpatient preadmission or preoperative assessment clinic. Types of Outcome This review will consider studies that include the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, recognition and fulfilment of postoperative care needs, patient anxiety.

Nurse‐led adult ENT pre‐operative assessment

Pre-operative assessment in some ENT departments is now nurse-led rather than doctor-led. Appropriately trained nursing staff can perform medical aspects of pre-operative assessment to the same or a better standard than a doctor. Almost all patients are satisfied with a nurse-led pre-operative assessment, and in some cases they prefer it.