Nurse-led pre-assessment for interventional procedures

Published: 15 November 2011

Brenda Munroe reviews the literature...

Background

The significance of pre-operative pre-assessment was originally acknowledged in the USA in the 1970s, with the concept emerging in the UK in the 1980s (Gilmartin et al, 2009; Healy and McWhinnie, 2003). Historically, surgical patients would be admitted to a ward at least one day before their planned operation, for investigations and medical assessment (Livingstone et al, 1993). This system proved to be inefficient, due to high rates of cancellation (attributable to unfavourable or unavailable test results) or patients failing to attend, which resulted in a waste of bed space. Gilmartin et al (2009) describe pre-assessment as an evolving concept utilised to reduce cancellations, ensure effective use of resources and promote better outcomes for patients.

And what is IR?

Interventional radiology (IR) is defined by the Department of Health (2010) as a minimally invasive alternative to open surgery or medical interventions that uses radiological image guidance. Interventional radiology has a significant impact on patient management within a broad spectrum of specialities (DH, 2010). Patients attending the radiology department are often acutely ill and unfit for surgery – for example, percutaneous transhepatic biliary drainage/stenting is often performed in patients with low bile duct strictures when endoscopy procedures fail (Francis and Watkinson, 2000) or peripheral angioplasty to salvage an ischaemic limb (DH, 2010). Jones and Taylor (2006) compare the role of the interventional radiology nurse to that of nurses working in theatre, with the added responsibility of caring for the conscious patient.

Nursing role

The Royal College of Radiologists (RCR) and RCN (2006) state that pre-assessment of planned admission is an established role of the interventional radiology nurse. Nurses working in this innovative field of practice require an in-depth knowledge of multiple disease processes and excellent assessment abilities (Goodhart and Page, 2007). Pre-assessment of planned admission enables the interventional radiology nurse to assess the patient’s suitability for treatment as either an in-patient or out-patient (Jones and Taylor 2006), thus, improving hospital efficiency and patients’ experiences (NHS, 2002).

What does the literature tell us?

In my workplace, I conducted a systematic literature review to evaluate the effectiveness of nurse-led pre-assessment clinics. I included forty-three studies, which were based on nurse-led pre-assessment/preoperative assessments/pre-admission assessments for adults, from the year 1993 to 2011.

The key themes to emerge from the literature were: efficiency, patient care, expanded role of the nurse and service enhancement. The review revealed that the effectiveness of the pre-assessment of patients undergoing interventional procedures is dependent on the nurses’ skills, experience and understanding of the procedures involved.

Consequently, the appropriate training of nurses to perform pre-assessment and keeping to a sufficient workload to maintain competencies, is paramount.

How do we stand?

In conclusion, nurses effectively pre-assessed patients for a wide range of procedures in a variety of settings. Nurses also enhanced the pre-assessment process. However, this review was limited due to a dearth of research on nurse-led pre-assessment for patients undergoing interventional procedures. This highlights the necessity for research in this unique area of practice. For more information on this literature review, please contact the newsletter at: community.editor@rcn.org.uk.

Department of Health (2010) Interventional radiology: Guidance for service delivery. A report from the national imaging board. London: HMSO. Available from: [Accessed 23 March 2011].
• Francis, I S and Watkinson, A F (2000) Interventional radiology explained. London: Remedica Publishing Limited.
• Gilmartin, J, Chin, H And Leonard, P (2009) Pre-admission clinics in day surgery. The ‘one-stop shop’: tools and methods for practice improvement and service development. Practice Development In Health Care, 8 (4), 10 November, pp.239–52.
• Goodhart, J and Page, J (2007) Radiology nursing. Orthopaedic Nursing, 26(1), pp.36–9.
• Healey, J and McWhinnie, D (2003) Pre-assessment at source. Journal of One-Day Surgery, 13 (1), pp.14–5.
• Jones, S and Taylor, E J (2006) Imaging for nurses. Oxford: Blackwell Publishing.
• Livingstone, J I et al. (1993) Role of pre-admission clinics in a general surgical unit: a 6-month audit. Annals of the Royal College of Surgeons of England, 75, pp.211–12.
• NHS Modernisation Agency (2002) National good practice guidance on pre-operative assessment for day surgery [online]. [Accessed 10 October 2010].
• Royal College of Radiologists and RCN (2006) Guidelines for nursing care in interventional radiology. (2nd Ed). London: Royal College of Radiologists.