Wittkugel Eric, Varughese Anna
Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Paediatr Anaesth. 2015 Jul;25(7):719-26. doi: 10.1111/pan.12640. Epub 2015 Apr 3.
Historically, anesthesiologists have conducted preanesthesia evaluation, but more recently, nurse practitioners (NPs) are increasingly assisting with the preanesthesia evaluation of children. In the current economic environment for healthcare, strategies to provide superior outcomes and exceptional patient experience at the lowest possible cost are constantly being explored. We examined whether well trained nurses, working alongside NPs, could safely and effectively assist in preanesthesia evaluation. The aim of this quality improvement project was to implement a new model for preanesthesia evaluation for healthy outpatient pediatric patients: nurse-assisted preanesthesia evaluation (NAPE).
Using quality improvement methods, Key Driver Diagrams and SMART aims gave direction for the training and clinical implementation of this new process. Using small tests of change and Plan-Do-Study-Act cycles, we developed a training process and a stepwise process to integrate them into the clinical work flow. The primary outcome measure was the proportion of the total preanesthesia evaluations in which the Anesthesia Nurses assisted. To ensure quality and safety, data on balancing measures and quality metrics were collected.
The weekly percentage of outpatients evaluated by Anesthesia Nurses increased from 0% to 55% within the first 4 months and was then sustained. The remaining patients were evaluated by the Anesthesia NPs. The balancing measures did not show any significant negative effect. Our perioperative quality metrics were also not changed significantly.
Using quality improvement methods, we successfully improved the utilization of staff resources by adding an Anesthesia Nurse-assisted preanesthesia evaluation program alongside our NPs to provide outstanding preanesthesia care at the lowest possible cost.
过去，麻醉医生负责进行麻醉前评估，但近年来，执业护士（NPs）越来越多地协助进行儿童麻醉前评估。在当前医疗保健的经济环境下，人们不断探索以尽可能低的成本提供卓越治疗效果和非凡患者体验的策略。我们研究了训练有素的护士与执业护士合作，是否能够安全有效地协助进行麻醉前评估。这个质量改进项目的目的是为健康的门诊儿科患者实施一种新的麻醉前评估模式：护士辅助麻醉前评估（NAPE）。
运用质量改进方法，关键驱动因素图和明确具体、可衡量、可实现、相关联、有时限的目标为这一新流程的培训和临床实施提供了指导。通过小规模的变更测试和计划-执行-研究-行动循环，我们制定了一个培训流程和一个逐步流程，将它们整合到临床工作流程中。主要结局指标是麻醉护士协助进行的麻醉前评估总数的比例。为确保质量和安全，收集了关于平衡措施和质量指标的数据。
在最初的4个月内，麻醉护士评估的门诊患者每周百分比从0%增加到55%，然后保持稳定。其余患者由麻醉执业护士评估。平衡措施未显示出任何显著的负面影响。我们的围手术期质量指标也没有显著变化。
通过运用质量改进方法，我们成功地提高了工作人员资源的利用率，在我们的执业护士之外增加了一个麻醉护士辅助麻醉前评估项目，以尽可能低的成本提供出色的麻醉前护理。
