"Waste not, want not": making better use of house officers in the Otolaryngology Department at Christchurch Hospital, New Zealand.

AIM

To quantify the surgical preadmission workload for ORL house officers, to outline a protocol for enhancing nurse-led preadmission, and to consider the effects of implementing nurse-led preadmission for selected patients.

METHODS

Clinical records for patients undergoing ORL procedures in February 2008 were retrospectively audited, noting ASA score, patient age, procedure type and duration, and duration of hospital stay. Adults undergoing inpatient procedures were deemed suitable for nurse-led preadmission if they had an ASA score of 1, procedure length <90 minutes, and were aged less than 60 for females and 50 for males.

RESULTS

171 procedures were performed in February, of which 164 (96%) were elective procedures, on patients with a mean age of 24 years, and range 0-93 years. The mean procedure length was 51 minutes, with a range 2-374 minutes. 92 patients were assessed as ASA 1, 62 as ASA 2, and 9 as ASA 3. The ASA score was not recorded for 1 patient. House officers do not preadmit paediatric day cases or cases performed under local anaesthesia. 23 (23%) of the 99 patients preadmitted by house officers fulfilled all three criteria for nurse-led preadmission.

SUMMARY

Surgical preadmission is a significant part of the workload for ORL house officers. Many patients who are preadmitted are well. Nurses currently preadmit paediatric day-case patients and we found no significant barriers to implementing nurse-led preadmission in a larger patient group. Patient safety is very unlikely to be compromised provided a strict protocol is followed for selection of appropriate patients. The time saving for house officers by implementing nurse-led preadmission is approximately 3 hours per week in our service.