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

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 pat...

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Main Authors: M B Nejthardt, P Alexandris, S Bechan, M F A Bijli, S Chetty, J M Dippenaar, M Gibbs, M Johnson, H Kluyts, R Llewellyn, M Motiang, P Mogane, P Motshabi, B Mrara, F Roodt, U Singh, S Spijkerman, E Turton, J van der Westhuizen, B Biccard
Format: Article
Language:English
Published: South African Medical Association 2024-02-01
Series:South African Medical Journal
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Online Access:https://samajournals.co.za/index.php/samj/article/view/1306
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author M B Nejthardt
P Alexandris
S Bechan
M F A Bijli
S Chetty
J M Dippenaar
M Gibbs
M Johnson
H Kluyts
R Llewellyn
M Motiang
P Mogane
P Motshabi
B Mrara
F Roodt
U Singh
S Spijkerman
E Turton
J van der Westhuizen
B Biccard
author_facet M B Nejthardt
P Alexandris
S Bechan
M F A Bijli
S Chetty
J M Dippenaar
M Gibbs
M Johnson
H Kluyts
R Llewellyn
M Motiang
P Mogane
P Motshabi
B Mrara
F Roodt
U Singh
S Spijkerman
E Turton
J van der Westhuizen
B Biccard
author_sort M B Nejthardt
collection DOAJ
description 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.
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spelling doaj-art-87a0f37017404ae9a7b4a36ce96e7adc2025-02-10T12:26:27ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-02-01114210.7196/SAMJ.2024.v114i2.1306The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensusM B Nejthardt0P Alexandris1S Bechan2M F A Bijli3S Chetty4J M Dippenaar5M Gibbs6M Johnson7H Kluyts8R Llewellyn9M Motiang10P Mogane11P Motshabi12B Mrara13F Roodt14U Singh15S Spijkerman16E Turton17J van der Westhuizen18B Biccard19Department 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 AfricaDepartment of Anaesthesia, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South AfricaDiscipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South AfricaDepartment of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDepartment of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDepartment of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South AfricaDepartment 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 AfricaDepartment of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDepartment of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South AfricaDepartment 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 AfricaDepartment of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South AfricaDepartment of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Chris Hani Baragwanath Hospital, Soweto, South AfricaDepartment of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Charlotte Maxeke Hospital, Johannesburg, South AfricaDepartment of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South AfricaDepartment of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; George Provincial Hospital, George, South Africa Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South AfricaDepartment of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South AfricaDepartment of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South AfricaDepartment of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South AfricaDepartment 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 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. https://samajournals.co.za/index.php/samj/article/view/1306anaesthesiahigh-risk patientspre-operativescreening tool
spellingShingle M B Nejthardt
P Alexandris
S Bechan
M F A Bijli
S Chetty
J M Dippenaar
M Gibbs
M Johnson
H Kluyts
R Llewellyn
M Motiang
P Mogane
P Motshabi
B Mrara
F Roodt
U Singh
S Spijkerman
E Turton
J van der Westhuizen
B Biccard
The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
South African Medical Journal
anaesthesia
high-risk patients
pre-operative
screening tool
title The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
title_full The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
title_fullStr The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
title_full_unstemmed The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
title_short The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus
title_sort development of a nurse led preoperative anaesthesia screening tool by delphi consensus
topic anaesthesia
high-risk patients
pre-operative
screening tool
url https://samajournals.co.za/index.php/samj/article/view/1306
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