The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus

Authors

  • M B Nejthardt Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
  • P Alexandris Department of Anaesthesia, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
  • S Bechan Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa
  • M F A Bijli Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • S Chetty Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
  • J M Dippenaar Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa
  • M Gibbs Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
  • M Johnson Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
  • H Kluyts Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  • R Llewellyn Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
  • M Motiang Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  • P Mogane Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Chris Hani Baragwanath Hospital, Soweto, South Africa
  • P Motshabi Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Charlotte Maxeke Hospital, Johannesburg, South Africa
  • B Mrara Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
  • F Roodt Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; George Provincial Hospital, George, South Africa
  • U Singh Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa
  • S Spijkerman Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa
  • E Turton Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
  • J van der Westhuizen Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
  • B Biccard Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i2.1306

Keywords:

anaesthesia, high-risk patients, pre-operative, screening tool

Abstract

Background. Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy.

Objective. To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations.

Methods. A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses’ screening tool for preoperative assessment.

Results. Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery.


Conclusion. A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.

References

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Published

2024-02-13

Issue

Section

Research

How to Cite

1.
Nejthardt MB, Alexandris P, Bechan S, Bijli MFA, Chetty S, Dippenaar JM, et al. The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus. S Afr Med J [Internet]. 2024 Feb. 13 [cited 2024 Dec. 10];114(2):e1306. Available from: https://samajournals.co.za/index.php/samj/article/view/1306

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