The accuracy of anesthesia-educated nurses in pre-anesthesia evaluation: A diagnostic accuracy study

The global shortage of anesthesiologists and increasing surgical demand have driven the adoption of task-shifting strategies, including delegating pre-anesthesia evaluations to registered nurses. While some results have been reported in high-income countries, limited evidence exists regarding the feasibility and safety of such practices in low- and middle-income countries with developing nurse education systems, such as China.

To evaluate the accuracy of pre-anesthesia evaluations conducted by nurses who had undertaken education in anesthesia in a specialized cancer hospital in China, using the assessment results of senior anesthesiologists as the reference standard. Secondary objectives included assessing the agreement on the American Society of Anesthesiologists classification and comparing the accuracy of pre-anesthesia evaluations by nurses with and without critical care experience.

This prospective cross-sectional study was conducted in a metropolitan teaching hospital in Southwest China. Pre-anesthesia evaluations performed by 24 anesthesia nurses were compared to those of five senior anesthesiologists for 1930 patients undergoing elective surgery with general anesthesia. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated. Agreement on the American Society of Anesthesiologists classification was assessed using the Kappa statistic.

Anesthesia nurses achieved an overall accuracy of 97.7 % (95 % CI: 97.0 %-98.3 %) for determining surgical readiness, with a sensitivity of 70.7 % (95 % CI: 57.3 %-81.9 %) and specificity of 98.6 % (95 % CI: 97.9 %-99.0 %). Positive and negative predictive values were 60.3 % (95 % CI, 47.7 %-72.0 %) and 99.1 % (95 % CI, 98.5 %-99.5 %), respectively. Agreement on the American Society of Anesthesiologists classification was substantial (Kappa = 0.712). Nurses with prior critical care experience demonstrated higher values in all accuracy metrics, although differences were not statistically significant.

Nurses with education in anesthesia demonstrated high overall accuracy and substantial agreement with senior anesthesiologists in performing pre-anesthesia evaluations, supporting their potential role in task-shifting strategies. Further improvements in accuracy may be achieved through enhanced training in cardiovascular assessment and the integration of supportive technologies. These findings provide valuable evidence for implementing nurse-led pre-anesthesia evaluations in low- and middle-income countries, but broader studies are needed to generalize these results to diverse clinical settings.