Impact of pre-assessment for children scheduled for day surgery to increase the effectiveness of the admissions process for patients, families and staff
In the United Kingdom a pre-assessment clinic was developed in a children’s hospital at the Oxford Radcliffe Hospitals in October 2007. The pre-assessment is intended to benefit the patients and family for day surgery service by offering play preparation of the procedure, communication between health providers, decreasing did-not-attend and cancellation rates (on the day of surgery), and written and verbal information. The focus of this study for these clinics was to decrease the did-not-attend (DNA) and cancellation rates from October 2007 -2008 to evaluate if the pre-assessment service should continue. Nurse led pre-operative assessment can possibly help decrease anxiety in children and parents (Callery 2005, Betz 2006, p. 33). It gives a chance for any questions and medical concerns to be asked and evaluated before surgery.
This study consisted of total of 521children from a total 205 pre-assessment clinics. The evaluation of this study was dependent on the rate of DNA or cancelled on the day of surgery. This information will help determine if pre-assessment is needed to increase the effectiveness and efficiency for day case surgeries. Assessment is essential before proceeding with a surgery, treatment or medical check-up. Therefore the pre-assessment service can reassure that the patient is ready for surgery from a nursing perspective. Children that are evaluated before surgery could be identified with any new or continuing psychological, physical, or social problems at an earlier time. New medical conditions may appear and so the nurses will have a chance to notify the doctor and the anaesthetists. Nurses may also help alleviate some anxiety with the parents by providing support and effective communication. Importantly, if a nurse can determine if a child is unsuitable before surgery or no longer needs treatment, it will save time and money (Finlay & Higson p. 37).
From these 521 cases, 497 children were pre-assessed and 12 children did not attend or cancelled on the day of surgery. Reasons for not attending were because of administration errors, medical reasons, family reasons, and cancellation based a medical condition noted at pre-assessment. Although there was only one child that cancelled due to pre-assessment, all preventable measures make a huge impact. As for the children who not pre-assessed, ‘a detailed examination of each case revealed that 14 of these could have been prevented by pre-assessment’ (Finlay & Higson, 2010, p. 36). During pre-assessment the nurse will be able to take vital signs, measure pulse rate and lungs sounds, and evaluate the patient overall. This will help keep a child out of risk if there are complications or any unidentified medical conditions on the day of surgery.
In June and July of 2008 fifty questionnaires were given randomly to pre-assessed patient and families which focused on the patients’ overall pre-assessment experience. The nurse and healthcare providers have provided effective support and communication because all families stated that they were given the opportunity to ask questions. The patients are properly informed and educated. The play preparation for families who attended found it very helpful to simulate the process with their child and the nurse. The nurse can be an important guide when teaching the patient and family how to plan for before and after the surgery. Conducting interventions that can involve the family is beneficial for the patient for before and after the surgery.
Pre-assessment at the clinics is conducted in a more efficient and effective manner for children’s day surgery. Nurses are helping to prevent any complications with their assessment. Children and families are well informed and prepared at admission. Families believe the timing of the pre-assessment is done promptly and properly. With the increase of positive results the overall process of pre-assessment appears to be fit to continue.
Finlay, T., Higson, J. (2010). Pre-assessment for children scheduled for day surgery. Nursing
Management, 17(8), 32-38.
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