The accuracy of trained nurses in pre-operative health assessment: results of the OPEN study.
We quantified the accuracy of trained nurses to correctly assess the pre-operative health status of surgical patients as compared to anaesthetists. The study included 4540 adult surgical patients. Patients' health status was first assessed by the nurse and subsequently by the anaesthetist. Both needed to answer the question: 'is this patient ready for surgery without additional work-up, Yes/No?' (primary outcome). The secondary outcome was the time required to complete the assessment. Anaesthetists and nurses were blinded for each other's results. The anaesthetists' result was the reference standard. In 87% of the patients, the classifications by nurses and anaesthetists were similar. The sensitivity of the nurses' assessment was 83% (95% CI: 79-87%) and the specificity 87% (95% CI: 86-88%). In 1.3% (95% CI: 1.0-1.6%) of patients, nurses classified patients as 'ready' whereas anaesthetists did not. Nurses required 1.85 (95% CI: 1.80-1.90) times longer than anaesthetists. By allowing nurses to serve as a diagnostic filter to identify the subgroup of patients who may safely undergo surgery without further diagnostic workup or optimisation, anaesthetists can focus on patients who require additional attention before surgery.
Department of Perioperative Care and Emergency Medicine, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands. w.a.vanklei@azu.nl
W A
WA
van Klei
P J
PJ
Hennis
J
J
Moen
C J
CJ
Kalkman
K G M
KG
Moons
D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000592:standards*; D002983:Clinical Competence; D000075202:Contraindications; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D004311:Double-Blind Method; D004509:Education, Nursing, Continuing; D017558:Elective Surgical Procedures; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners / Q000193:education / Q000592:standards*; D009730:Nursing Assessment / Q000592:standards*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D011300:Preoperative Care / Q000592:standards*; D013997:Time Factors