Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
Department of Anaesthesia, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa.
S Afr Med J. 2024 Feb 13;114(2):e1306. doi: 10.7196/SAMJ.2024.v114i2.1306.
Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy.
To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations.
A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses' screening tool for preoperative assessment.
Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery.
A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.
中低收入国家严重缺乏专科麻醉师。大多数接受手术的患者围手术期风险较低。如果无法立即获得术前专科护理，一种适当的临时策略可能是确保只有高风险患者在术前由专科医生进行检查。利用护士管理的术前筛查工具，根据疾病负担匹配人力资源，以识别可能从手术日前接受专科审查中获益的高风险患者，可能是一种有效的策略。
开发一种由护士管理的术前麻醉筛查工具，以识别最有可能从手术日前的专科审查中获益的患者，以及那些可以由麻醉师在手术日当天安全检查的患者。这将确保高危患者有足够的时间进行术前优化，并限制可避免的手术日取消。
系统回顾旨在确定用于三轮 Delphi 共识过程的术前筛查问题。一个由 16 名具有丰富经验的全职临床麻醉师组成的小组代表南非所有大学附属麻醉科参与，定义了护士用于术前评估的筛查工具。
确定了 98 项研究，产生了 79 个问题。此外，协调员还添加了另外 14 项内容，为第一轮创建了 93 个问题列表。最终的筛查工具包括 81 个问题，其中 37 个问题被认为是识别需要在手术日前由专科医生检查的患者的关键问题。
提出了一种结构化的护士管理术前筛查工具，以识别可能从及时的术前专科麻醉师审查中获益以避免手术日取消的高风险患者。
