The accuracy of trained nurses in pre-operative health assessment: results of the OPEN study

Abstract

SummaryWe quantified the accuracy of trained nurses to correctly assess the pre-operative health status of surgical patients as compared to anaesthetists. The study included 4540 adult surgical patients. Patients' health status was first assessed by the nurse and subsequently by the anaesthetist. Both needed to answer the question: 'is this patient ready for surgery without additional work-up, Yes ⁄ No?' (primary outcome). The secondary outcome was the time required to complete the assessment. Anaesthetists and nurses were blinded for each other's results. The anaesthetists' result was the reference standard. In 87% of the patients, the classifications by nurses and anaesthetists were similar. The sensitivity of the nurses' assessment was 83% (95% CI: 79-87%) and the specificity 87% (95% CI: 86-88%). In 1.3% (95% CI: 1.0-1.6%) of patients, nurses classified patients as 'ready' whereas anaesthetists did not. Nurses required 1.85 (95% CI: 1.80-1.90) times longer than anaesthetists. By allowing nurses to serve as a diagnostic filter to identify the subgroup of patients who may safely undergo surgery without further diagnostic workup or optimisation, anaesthetists can focus on patients who require additional attention before surgery.

The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals

“…To get an impression of the recent developments in preoperative evaluation and to be able to make thorough questions for the face-to-face interviews, Pubmed and EBSCOhost ® Academic Search Elite databases were used to search for literature concerning the organization, implementation and cost-effectiveness of preoperative evaluation in hospitals. The literature which was selected consisted of studies on (guidelines for) preoperative evaluation by anaesthesiologists and on OPE clinics [1][2][3][4][5][6][7][12][13][14][15][16][17]. In this, special attention was paid to the study of van Klei and colleagues, which was considered as the pilot study of the present study.…”

“…Literature about the most recent development regarding OPE clinics in Dutch hospitals, namely the employment of nurses substituting anaesthesiologists, was also taken into account [15,17].…”

European Perspectives

“…He explains, "Two articles are particularly important, one in 2002 in Anesthesia and Analgesia 5 and one in 2004 in Anaesthesia, 6 for which we developed a preoperative clinic and then showed that it led to fewer cancellations. It is better for people to come to our clinic before surgery so we have time to assess and educate them."…”

Pride and prejudice

“…We have continually refined our practice to ensure that high-risk patients have a better chance of surviving major surgery [5]. We have been open and enquiring to new ways of working in multi-disciplinary partnerships [6,7], and we have gone back to the laboratory to consider the basic building blocks of our science [8,9]. We have fearlessly re-examined the sacred cows taught us by our predecessors, and discarded them where evidence is lacking or outcomes perverse [10][11][12].…”