AB215. 233. Routine screening of elective surgery patients admitted through the pre-operative assessment clinic

Background: With increasing demands on the surgical services in Ireland, it is vital that patients are pre-operatively assessed in a safe and efficient manner. With patient safety in mind, today’s surgeons and anaesthetists also have to balance appropriate pre-operative testing. Unnecessary pre-operative testing leads to increasing health costs and increased chance of false-positives which can have negative outcomes in patient care. The National Institute for Clinical Excellence (NICE) has set out guidelines (NG), NG45, in order to provide direction on appropriate pre-operative investigations. The pre-operative assessment clinic (POAC) provides a service which can safely and efficiently evaluate patients before operations. The aim of this audit was to examine the compliance of pre-operative screening of patients admitted through POAC.

Methods: For a three-week period, 50 elective surgical cases were selected that had been admitted through POAC. Using NG45, 12 pre-operative screening investigations were tracked. The investigations which are documented through a standardized POAC form were then assessed for appropriateness based on the surgical category and America Society of Anesthetist (ASA) grade that correlates to NG45 guiding principle.

Results: Overall compliance with NG45 was 84% (217/258). Significant findings of pre-operative electrocardiogram screening of 83% (38/46). While urine dipstick and chest X-ray were both 69% (11/16). Highest compliance was seen with pregnancy screening 100% (16/16)

Conclusions: The POAC showed overall good compliance with NG45; many unnecessary investigations were avoided through proper screening of the patient’s history as well as previous investigative results. The audit shows that PAOC can be a safe and efficient means to pre-operative assessment.

Keywords: Pre-operative screening; routine screening; NG45