Pre-assessment Clinics Research Articles

Waiting for healthcare: a concept analysis

This paper is a report of an analysis of the concept of waiting for health care from the client's perspective. Waiting is commonplace in many areas of health care and has become a topical and politically important issue in the provision of healthcare services. Whilst managers and governments search for solutions to this problem, it is important that this aspect of clients' healthcare experience is examined to evaluate its impact and implications for nursing practice. The PubMed and CINAHL databases (dating from 1950 and 1982 to 2007 respectively) were searched using the keywords 'health care' and 'waiting'. The reference lists of papers identified were also checked and this revealed literature from a number of other disciplines related to the concept. Waiting for health care is identified as an unspecified yet measurable period of time between identification of a healthcare problem and its diagnosis and treatment, when clients experience uncertainty and powerlessness whilst anticipating a disease outcome. The critical attributes of waiting for health care are: a period of measured time, subjective interpretation of the perceived significance of the measured time, feeling uncertain and powerless and anticipation of a response to the healthcare need. Strategies that facilitate contact with clients through pre-assessment clinics and giving written information and a contact point may seem obvious but are currently overlooked in busy healthcare environments. This is an area where nurses can lead in the delivery of person-centred care and could potentially increase satisfaction with how waiting is managed.

Nurse-led Preassessment Clinics: A Cautionary Tale Revisited

Graduated compression stockings are widely used as prophylaxis for post-operative deep vein thrombosis (DVT). Their simplicity and lack of side effects facilitates routine prescription by nursing staff. The manufacturers do, however, caution against their use in patients with peripheral vascular disease (PVD). This case highlights the risk of ischaemic complications associated with the use of graduated compression stockings perioperatively.

Pre-operative Assessment – Setting A Standard Through Learning Ellen Janke University of Southampton 178pp plus CD Rom; £65

This book was written through collaboration between the University of Southampton and the NHS modernisation agency. It focuses on the processes involved in effective pre-operative assessment with surgical patients. The chapters include: reasons to assess pre-operatively, cardiovascular and respiratory assessment, the airway, common conditions and planning of care. The chapters focusing on cardiac and respiratory assessment are particularly creditworthy. The text is easy to read and is presented in a logical and coherent format, with clearly identifiable titles, so that readers can quickly find the information they require. This book would be extremely useful to nurses working in pre-assessment clinics and surgical units. Owing to its specialist nature, and its price, I would not suggest nurses buy it; however, four copies have been distributed to each English trust.

Comparison of the automated Dinamap blood pressure monitor with the mercury sphygmomanometer for detecting hypertension in the day case pre-assessment clinic

Patients will be rejected from surgery by nurse-led pre-assessment clinics and will need to be assessed by their general practitioners if their blood pressure is higher than a pre-determined value. We have assessed the accuracy of the Dinamap automatic blood pressure recorder compared with manual mercury sphygmomanometry for detecting pre-operative hypertension in the day case pre-assessment clinic under everyday conditions. Two hundred consecutive patients attending for day case surgery pre-assessment had their blood pressure measured using the automated and the manual methods. We found that the Dinamap over-read systolic blood pressure by a mean of 8.38 mmHg and under-read diastolic pressure by a mean of 1.68 mmHg when compared with manual readings. Of the patients 6.5% would have been inappropriately diagnosed as hypertensive using the Dinamap and thus potentially rejected from day surgery and inappropriately referred to their general practitioner.

The effects of a preassessment clinic on nonattendance rates for day-case colonoscopy.

Nonattendance for colonoscopy contributes to an increase in the waiting lists for this procedure. Preassessment clinics routinely run for a number of day-patient surgical procedures have been shown to reduce nonattendance rates by enhancing patient understanding. This study aimed to determine prospectively whether preassessing patients booked for colonoscopy would lead to a reduction in the nonattendance rate. Nonattendance rates for colonoscopy were assessed in consecutive 9-month periods. During the first period all patients were mailed appointments for colonoscopy with dietary and purgative bowel preparation instructions. During the second period, patients who had never previously undergone a colonoscopic examination were invited to attend a preassessment clinic, while patients who had attended for colonoscopy in the past were sent appointments and purgative instructions in the post. 344 colonoscopies were booked in the first 9-month period and 350 in the second, of which 195 were preassessed. Overall, 60 patients did not attend for colonoscopy during the first 9-month period (17.4%), and 40 (11.4%; P<0.05) did not attend during the second period of study. During the second 9 months only six (3.1%) of the 195 preassessed patients did not attend for colonoscopy, in comparison with 34 (22%; P<0.0001) of the 155 patients not preassessed. By running a limited preassessment clinic for patients due for colonoscopy, we have shown a significant reduction in the nonattendance rate. If all patients were to attend for preassessment, nonattendance rates for colonoscopy might be reduced to that seen in our preassessment group (3.1%).

Optimisation of outpatient resource utilisation in cataract management.

We assessed whether patients referred with a diagnosis of cataract require outpatient assessment before listing for surgery or whether the general practitioner could have direct access to the waiting list. We also studied whether pre-assessment clinics made a significant difference to management even when waiting times were long. Data about patients referred with a diagnosis of cataract to the Oxford Eye Hospital and associated hospitals were collected. Seventy-five patients were prospectively studied and 100 patient records were retrospectively analysed. Twenty-six per cent of patients had a misdiagnosis or additional problems affecting management. Optometrists provided more information than general practitioners, but their diagnostic accuracy was equal (73% optometrists, 75% general practitioners). At the pre-assessment clinic pupil dilatation changed management in only 4% of patients. Listing patients on the basis of referral letters would be inappropriate in 1 in 4 patients. Pre-assessment clinics rarely picked up a clinically relevant change. Thus if outpatient consultation included a decision on the exact surgical plan including implant power, then pre-assessment clinics may not be necessary.

Nurses achieve quality with pre-assessment clinics

Nurses achieve quality with pre-assessment clinics

Nurses achieve quality with pre‐assessment clinics

Nurses in a group of Wolverhampton Hospitals carried out a local research study to identify not only the level of patient satisfaction with pre-assessment clinics (PAC), but also what care nurses delivered in these clinics. Data were collected using both ethnographic and survey methods. Patients found the PAC visit valuable: it reduced stress and provided much needed information about the coming surgery. The skills nurses used and the tasks carried out were consistent throughout the Trust, and reflected the provision of a high standard of care.

Nurses achieve quality with pre-assessment clinics

Nurses achieve quality with pre-assessment clinics

Development of day case cataract surgery: a literature review.

There is increasing demand for day case cataract surgery. This review looks at the varying criteria for suitable patients and compares the use of local or general anaesthesia for day surgery. Preassessment clinics and the possible limitations of patient transport are discussed. Length of stay in the day unit, nurse involvement and discharge procedures are examined. Postoperative visits are reviewed. Studies show that the clinical outcome is not affected by outpatient surgery and that patients report a high level of satisfaction with their day care. Day case cataract surgery is safe and cost-effective and increased patient demand will become a significant factor favouring day case surgery in the future. Further research into patients' attitudes to the continuity of nursing care from preoperative assessment, through surgery to discharge, and whether this plays a part in their overall satisfaction, is recommended.