Reed M, Wright S, Armitage F
Department of Surgery and Anaesthetic Sciences, Royal Hallamshire Hospital, Sheffield, UK.
J R Coll Surg Edinb. 1997 Oct;42(5):310-3.
A nurse-led Pre-operative Assessment Clinic was introduced into the General Surgical Directorate at the Royal Hallamshire Hospital in August 1993 to provide a general medical and anaesthetic pre-operative assessment, to give information, both written and verbal, to patients about their operations and to identify social problems which might delay discharge. Patients were seen either at the time of their original clinic appointment or subsequently on a recall basis, prior to admission to hospital. The clinic was run by two out-patient nurses working to agreed protocols. Patients were given written information leaflets in addition to a verbal explanation about their admission and operation. In order to assess the effectiveness of the clinic, a group of patients attending during the first year were compared with similar patients who did not undergo pre-operative assessment. A questionnaire of satisfaction with information received was completed and compliance with the clinic protocols was recorded. In the pre-operative assessment group, patients were more satisfied with the amount of information received and there were significantly fewer cancellations due to unforseen medical problems in this group. Eighteen per cent of investigations were repeated unnecessarily because the reports were unavailable or considered out of date. However, only 1% of patients pre-operatively assessed had their operations cancelled after their admission, compared with 6% of non pre-operatively assessed patients. Given the total number of patients admitted for surgical procedures per year, the introduction of comprehensive pre-operative assessment for all patients could result in a substantial reduction in cancellations following admission.
1993年8月，皇家哈勒姆郡医院普通外科引入了由护士主导的术前评估诊所，以提供全面的医学和麻醉术前评估，向患者提供有关其手术的书面和口头信息，并识别可能延迟出院的社会问题。患者在最初预约诊所时或随后在召回时、入院前接受诊治。该诊所由两名门诊护士按照商定的方案运作。除了对患者的入院和手术进行口头解释外，还向他们提供书面信息传单。为了评估诊所的效果，将第一年就诊的一组患者与未接受术前评估的类似患者进行了比较。完成了一份关于对所获信息满意度的问卷，并记录了对诊所方案的遵守情况。在术前评估组中，患者对所获信息量更满意，该组因不可预见的医疗问题而取消手术的情况明显较少。18%的检查被不必要地重复，因为报告不可用或被认为过时。然而，术前接受评估的患者中只有1%在入院后取消了手术，而未接受术前评估的患者中这一比例为6%。考虑到每年接受外科手术的患者总数，对所有患者引入全面的术前评估可能会大幅减少入院后的取消手术情况。
