Is pre-operative patient assessment effective? A prospective trial of 100 patients

The working patterns of clinical postgraduate trainees are being scrutinised in preparation for the implementation of new, structured and shortened postgraduate specialist training programmes. Current practice in the National Health Service dictates, in all branches of surgery, the evaluation of elective admissions undergoing procedures under general anaesthetic by a junior trainee (SHO or HO) who then arranges the appropriate preoperative investigations. This doctor acts as a "generalist' in that he is primarily concerned with the patient's general fitness for the operation as well as with the specific condition to be treated. The anaesthetist also evaluates the patient prior to the operation. In his case his sole concern is to whether or not the patient is fit for a general anaesthetic. This prospective study investigated the extent of duplication in preoperative elective patient assessment by both the otolaryngology trainee and the anaesthetist in order to answer the question: are both assessments necessary? The medical records of 100 consecutive adult elective admissions to the Leicester Royal Infirmary Otolaryngology Department which provides inpatient services to a catchment population of 900,000 were reviewed. The case histories obtained by clinicians blind to the study were classified as positive or negative for relevant features. The case histories obtained by the otolaryngology trainee and anaesthetist showed a level of disagreement which was 9 per cent greater than chance. It appears that there is a low level of duplication in preoperative elective otolaryngology patient assessment and both otolaryngology trainee and anaesthetic examination are of value.