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Canadian Journal of Anesthesia

, 46:1117 | Cite as

Can nurses screen all outpatients? Performance of a nurse based model

  • Himat Vaghadia
  • Carolyn Fowler
Reports of Investigation

Abstract

Purpose

This paper outlines and evaluates a nurse based model for screening outpatients that is utilized in our free standing Surgical Day Care Centre (SDCC).

Methods

For 668 outpatients presenting at our SDCC, the attending anesthesiologist completed a study survey that was designed to identify: completeness of history; important concerns as judged by the pre-admission nurse; whether the patient was seen in the anesthesia preadmission clinic (PAC) for a consultation; if there was a delay in SDCC, the duration and reasons for the delay; whether in the opinion of the attending anesthesiologist the patient should have had an anesthetic consultation; whether the patient was canceled and the reason for cancellation.

Results

A nurse based model for screening all outpatients in a university affiliated tertiary hospital day care unit had an accuracy of 81 %, specificity of 86%, sensitivity of 46% and a negative predictive value of 92%. The cancellation rate with this model was 1.4%(8/551) and the case delay rate was 3.4%(l 9/551). The referral rate to anesthesiology staff was 17.5%( 117/668) and the referral rate to the PAC for anesthetic consultation was 5.1%(34/668).

Conclusions

The use of the nurse based model allowed for the efficient use of anesthesia and surgical day care centre resources. The model was better at ‘ruling out’ patients who do not need to be seen by anesthesiology ahead of the day of surgery rather than ‘ruling in’ patients who need to be seen by anesthesiology.

Keywords

Referral Rate Cancellation Rate Vancouver General Hospital Staff Anesthesiologist Audit Form 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Le présent article trace les grandes lignes d’un modèle-nursing, pour la sélection des patients ambulatoires, utilisé à notre Centre de chirurgie d’un jour (CCJ).

Méthode

L’anesthésiologiste en service a rempli un questionnaire d’étude, pour les 668 patients qui se sont présentés à notre CCJ, conçu pour enregistrer : l’anamnèse complète, les préoccupations importantes selon l’infirmière de la préadmission; le fait d’une consultation à la clinique de préadmission en anesthésie (CPA); la survenue d’une annulation et sa raison d’être; l’opinion de l’anesthésiologiste quant à la pertinence d’une consultation anesthésique préalable; le fait d’une annulation de l’opération et la raison qui l’a motivée.

Résultats

Un modèle-nursing pour la sélection des patients ambulatoires, dans une unité de soins ambulatoires d’un hôpital tertiaire affilié à l’université, présentait une fiabilité de 81 %, une spécificité de 86 %, une sensibilité de 46 % et une valeur de prédiction négative de 92 %. Avec ce modèle, le taux d’annulation a été de 1,4 % (8/551) et le taux de report des interventions a été de 3,4 % (19/551). On a dirigé 17,5 % (117/668) des patients vers le personnel d’anesthésiologie et 5,1% (4/668) vers la CPA pour une consultation anesthésique.

Conclusion

L’utilisation d’un modèle basé sur la pratique du nursing a permis l’usage efficace des ressources du centre de chirurgie et d’anesthésie ambulatoires. Le modèle a été meilleur pour «exclure» des patients qui n’avaient pas besoin de rencontrer l’anesthésiologiste avant le jour de l’opération plutôt que pour «accepter» ceux qui en avaient besoin.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  1. 1.Department of Anaesthesia (LSP 2449)Vancouver General HospitalVancouverCanada
  2. 2.Departments of Health Care & EpidemiologyUniversity of British ColumbiaVancouver

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