Nurse-led general surgical pre-operative assessment clinic

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 Eighteen per cent of investigations were repeated unnecessarily because the reports were unavailable or considered out of date.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.