Effectiveness of the clinical nurse specialist in preadmission testing

Prospective payment has led health care providers to shorten hospital stays wherever possible. Cutting costs by shortening stays has particularly affected the care surgical patients receive. Formerly, patients were admitted one or more days before a planned surgery for medical workup, laboratory testing and patient teaching. Today, hospitals nationwide admit patients scheduled for many types of surgery on the day surgery is performed. Preoperative testing programs have been established in hospitals across the country to replace the inpatient preoperative testing and assessment period (Anderson and Zimbra 1986; Connaway and Blackledge 1986; Worley 1986). These programs provide the necessary medical workup, but most fail to include the elements of preoperative care performed by nurses (Kemaghan 1985). Comprehensive preoperative nursing assessment, patient education, and discharge planning, essential components of quality surgical nursing care, have been jeopardized in this process. Clearly, payor policies encouraging providers to control costs were not meant to result in poor quality care. In the case of elective surgical patients, however, that possibility currently exists when preoperative nursing care is compressed into a very brief period just prior to the surgery itself. In order to enhance the efficiency and effectiveness of the care provided, appropriate nursing care must be available in preadmission programs. By this reallocation of nursing manpower, nurses can plan and establish priorities for management of patient care in a low-cost environment and can initiate appropriate interventions for the inpatient period and for discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)