Pre-operative Assessment and Patient Preparation The Role of the Anaesthetist 2 January 2010

1. Pre-operative Assessment and Patient PreparationThe Role of the Anaesthetist 2January 2010

2. From Preoperative assessment to Preoperative assessment and patient preparation January 2010 November 2001

3. Purpose • Enhance and optimise quality of patient care • Minimise last minute cancellations • Promote efficient use of staff and resources • Increase theatre throughput • Establish a patient care pathway • At all times ensure patient safety

4. When? • Before planned admissions • After planned admissions • After unplanned admissions

5. Preoperative preparation • Anaesthetists should take a central role in organisation of pre-operative services • This involves more than just preparing and delivering anaesthesia

6. Skill mix • The anaesthetist has the skills necessary to • assess, optimise and estimate risk • support patients deciding whether to proceed with surgery and anaesthesia

7. Preoperative assessment services should • Minimise risk for all patients • Identify patients at particularly high risk • Work with primary care to achieve these aims

8. Nurse practitioners • Pre-operative assessment is an extended role for nurse practitioners • They should work closely with anaesthetists with a special interest in pre-operative assessment and preparation • They are safe and cost-effective members of the team

9. After scheduled admissions • Anaesthetists must confirm that the patients have been prepared adequately so that anaesthesia and surgery can proceed safely

10. Tests and investigations • Should conform to national and local guidelines • ‘Routine’ tests are often superfluous, unnecessary and wasteful of resources

11. Time commitment • Most anaesthetic departments should plan for one consultant whole-time equivalent to run and manage daily high-risk clinics with appropriate secretarial support

12. Care pathways • Anaesthetic departments should establish clear pathways of care for unplanned admissions with surgeons, emergency departments, critical care and theatre personnel

13. Special considerations • Special considerations should be given to • Children • Adults and children with disabilities and special needs

14. Management • Clinical directors for anaesthesia and theatres should work with appropriate managers to establish comprehensive and integrated pre-operative assessment facilities and ensure that there is a lead for pre-operative assessment • Time required to deliver these services should be reflected in the job plans of individuals as appropriate