title: Development of a nurse-assisted preanesthesia evaluation program for pediatric outpatient anesthesia.
abstract: BACKGROUND
  Historically, anesthesiologists have conducted preanesthesia evaluation, but more recently, nurse practitioners (NPs) are increasingly assisting with the preanesthesia evaluation of children. In the current economic environment for healthcare, strategies to provide superior outcomes and exceptional patient experience at the lowest possible cost are constantly being explored. We examined whether well trained nurses, working alongside NPs, could safely and effectively assist in preanesthesia evaluation. The aim of this quality improvement project was to implement a new model for preanesthesia evaluation for healthy outpatient pediatric patients: nurse-assisted preanesthesia evaluation (NAPE).
  
  
  METHODS
  Using quality improvement methods, Key Driver Diagrams and SMART aims gave direction for the training and clinical implementation of this new process. Using small tests of change and Plan-Do-Study-Act cycles, we developed a training process and a stepwise process to integrate them into the clinical work flow. The primary outcome measure was the proportion of the total preanesthesia evaluations in which the Anesthesia Nurses assisted. To ensure quality and safety, data on balancing measures and quality metrics were collected.
  
  
  RESULTS
  The weekly percentage of outpatients evaluated by Anesthesia Nurses increased from 0% to 55% within the first 4 months and was then sustained. The remaining patients were evaluated by the Anesthesia NPs. The balancing measures did not show any significant negative effect. Our perioperative quality metrics were also not changed significantly.
  
  
  CONCLUSIONS
  Using quality improvement methods, we successfully improved the utilization of staff resources by adding an Anesthesia Nurse-assisted preanesthesia evaluation program alongside our NPs to provide outstanding preanesthesia care at the lowest possible cost.
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Wittkugel
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Varughese
mesh_terms: D000758:Anesthesia / Q000451:nursing*; D000776:Anesthesiology / Q000592:standards*; D002648:Child; D002983:Clinical Competence / Q000706:statistics & numerical data*; D006801:Humans; D009722:Nurse Practitioners; D010045:Outpatients; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement
keywords: anesthesia; health manpower; nurse practitioner; preoperative care; quality improvement; resources