Impact of a nurse practitioner-assisted preoperative assessment program on quality

BACKGROUND: The anesthesia manpower shortage in the last few years in the US has limited many hospital pediatric surgical services. We sought to meet an increasing surgical caseload, while providing safe, timely and patient-centered care by instituting a nurse practitioner-assisted preoperative evaluation (NPAPE) program. The strategic goal of this program was to shift anesthesiologists from the preanesthesia clinic to the operating room (OR), while maintaining the quality of preoperative care. Our study sought to evaluate the quality of the NPAPE program. METHODS: One thousand five hundred and nine children aged 1 month-18 years, 463 parents, 25 anesthesiologists and 20 preoperative clinic nurses were studied. Indicators of quality were incidence of respiratory complications (apnea/hypopnea, laryngospasm, bronchospasm, and supplemental oxygen use in postanesthesia care unit), patient preoperative preparation time and parent and staff (anesthesiologists and preoperative clinic nurse) satisfaction. These indicators were recorded for 1 week every 3 months for 1 year. The first week (baseline) was an anesthesiologist-only preoperative assessment (three anesthesiologists performing approximately 120 evaluations per day). The subsequent four data collection weeks at 3, 6, 9, and 12 months were nurse practitioner (NP)-aided preoperative assessments (one anesthesiologist with six NPs performing approximately 120 evaluations per day). RESULTS: The incidence of respiratory complications, patient preoperative preparation time, and levels of parental satisfaction did not differ significantly between anesthesiologist-only and NP-aided assessments. However, anesthesiologist and preoperative clinic nurse satisfaction increased significantly postimplementation of the program. CONCLUSIONS: Our study revealed that within a year of its implementation, the NPAPE program maintained patient safety, timeliness, and a high level of parent satisfaction as well as increased staff satisfaction, while shifting two anesthesiologists to the OR. A NP-assisted preoperative evaluation program can offer operational advantages without compromising care.