Seeley Matthew, Stevenson D Scott
Christchurch School of Medicine, Christchurch, New Zealand.
N Z Med J. 2009 Apr 3;122(1292):44-9.
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.
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.
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.
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.
量化耳鼻喉科住院医师手术入院前的工作量，概述加强护士主导的入院前准备工作的方案，并考虑对选定患者实施护士主导的入院前准备工作的效果。
回顾性审核2008年2月接受耳鼻喉科手术患者的临床记录，记录美国麻醉医师协会（ASA）评分、患者年龄、手术类型和时长以及住院时长。接受住院手术的成年患者，若ASA评分为1、手术时长<90分钟、女性年龄小于60岁且男性年龄小于50岁，则被视为适合护士主导的入院前准备。
2月共进行了171例手术，其中164例（96%）为择期手术，患者平均年龄为24岁，年龄范围为0至93岁。平均手术时长为51分钟，范围为2至374分钟。92例患者ASA评分为1，62例为ASA 2，9例为ASA 3。1例患者未记录ASA评分。住院医师不负责小儿日间手术病例或局部麻醉下进行的病例的入院前准备。住院医师提前收治的99例患者中，23例（23%）符合护士主导的入院前准备的所有三项标准。
手术入院前准备是耳鼻喉科住院医师工作量的重要组成部分。许多提前收治的患者情况良好。护士目前负责小儿日间手术患者的入院前准备，我们发现对更大患者群体实施护士主导的入院前准备没有重大障碍。只要遵循严格的方案选择合适的患者，患者安全极不可能受到影响。在我们的服务中，实施护士主导的入院前准备为住院医师每周节省的时间约为3小时。
