Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update

Sonia Hines; Judy Munday; Kate Kynoch

doi:10.11124/jbisrir-2015-1996

Background: Nurse-led preadmission clinics or services have been implemented in many health services as a strategy to facilitate the admission and assessment of booked surgical cases. In order to provide the most recent available evidence, this systematic review is an update of our previous review published in 2010. Objectives: The objective of this review was to integrate recent research with a previously published systematic review on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. Inclusion criteria: Types of participants - The review considered studies that included adult or pediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient. Types of interventions - The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic. Types of outcomes - This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and patient or parent satisfaction. Types of studies - The review update considered any randomized controlled trials published after 2009; in the absence of randomized controlled trials other research designs, such as non-randomized controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. Search strategy: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in each component of this review. Methodological quality: Methodological validity was assessed by two reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data extraction: Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Data synthesis: Due to the clinical heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. Results: Four new studies were identified from searches and added to the 19 studies from the previous review for a total of 23 studies. There is weak evidence to suggest nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, length of stay, adverse surgical events and morbidity. Similarly weak evidence suggests nurse-led preadmission services may improve patient preparation, recognition of postoperative needs and patient/parent satisfaction. Conclusions: While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low. Implications for practice: Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety; however current the evidence level is low. Nurse-led preadmission services may improve patient preparation, recognition of postoperative needs and patient/parent satisfaction with the surgical process; however the current evidence level is low. There is little evidence to suggest that nurse-led preadmission services have an effect on adverse surgical events or morbidity. There is no evidence to suggest that nurse-led preadmission services have an effect on mortality rates. Implications for research: Currently the overall level of evidence regarding nurse-led preadmission services is low and more rigorous studies are required for all the examined outcomes.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update

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