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Nurse-led assessment clinics reflected in new pre-op guidance

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Healthy patients should need “few, if any” tests before undergoing planned surgery, according to updated official guidance for the NHS, which highlights the increasing role of nurse-led assessments.

The revised guidance, issued today by the National Institute for Health and Care Excellence, reflects radical changes in pre-operative checks including wide use of nurse-led assessment clinics.

“This updated guidance is a valuable tool that will enable healthcare professionals undertaking pre-operative assessment to feel confident”

Audrai Morgan

It said the number of routine tests carried out on patients who are reasonably healthy or having fairly minor surgery should be reduced.

Meanwhile, the results of tests done at GP surgeries should be flagged up when patients are referred for surgery to avoid them being done again unnecessarily.

The document updates guidelines issued in 2003, with the aim of reducing needless tests that can cause stress for patients, delay treatment and waste NHS money.

“Too much pre-operative testing may cause anxiety in patients, delays in treatment and further unnecessary treatments without influencing the outcome or changing how patients are managed during surgery,” said consultant anaesthetist Dr Ian Smith, who chaired the guideline development group.

“We have therefore extensively revised and simplified the original 2003 NICE guidance,” he said.

“Under the new guidance, patients who are reasonably healthy or having relatively non-invasive surgery should need few, if any preoperative tests,” he added.

“Patients who are reasonably healthy or having relatively non-invasive surgery should need few, if any preoperative tests”

Ian Smith

Developments in practice include the fact most patients are now seen well in advance of surgery in nurse-led preoperative assessment clinics, where a detailed medical history is taken and physical examination carried out to see if patients are fit for surgery and an anaesthetic.

Other changes include the fact random blood glucose testing to see if someone has diabetes have largely been dropped, while new tests like echocardiograms are being used much more.

While the guidance is intended to reduce unnecessary testing, it strengthens recommendations on pre-surgery pregnancy tests.

A pregnancy test should be carried out – with consent – if there is “any doubt” about whether a woman may be pregnant.

Professor Mark Baker, clinical practice director for NICE, said there had been a reduction in the number of routine tests ordered for young, healthy patients having elective minor surgery since 2003 – with nurse-led clinics helping to cut the number. However, unnecessary tests were still being ordered.

Mark Baker

Mark Baker

Mark Baker

“When you consider that in 2014-15 the NHS carried out 9.9 million operations, it’s apparent that even a small percentage of unnecessary testing can affect large numbers of patients and have a significant impact on costs,” he said.

Audrai Morgan, re-assessment lead nurse and guideline group member, said the updated guidance was a useful resource for nurses and others.

“This updated guidance is a valuable tool that will enable healthcare professionals undertaking pre-operative assessment to feel confident that the tests they are doing are the right ones for finding out whether patients are fit to have surgery,” she said.

“Just as importantly, it will help to ensure the best possible post-operative outcomes for patients,” she added.

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