B59-02 How a Specialised Nurse-Led Respiratory Assessment Can Identify Incremental Respiratory Risk in Pre-Operative Cardiac Surgery Patients

Rationale Current risk stratification tool (RST) used for pre-operative cardiac surgical patients in the United Kingdom (UK) may not accurately reflect the overall risk of surgery. Specialist nurse-led respiratory assessment can help identity incremental risk, which can impact patient and clinician decision-making regarding treatment. This pathway ensures that the risk quoted reflects the patient’s actual clinical risk. Methods A review of pre-operative assessments completed between October 2024 and October 2025 at SGH was conducted. Pre-operative assessments and investigations included comprehensive history taking and pulmonary function tests as outlined by Madden et al. (2025). The results were analysed and if indicated, were reviewed with a respiratory consultant where additional investigations were requested. Over this period, 157 patients met criteria for respiratory assessment, with 218 consultant review episodes (ranging from 1-3 per patient). Results From the 157 patients, 18 (11%) were identified as having additional incremental risk of 5-20% from a respiratory standpoint- beyond the risk score calculated from a RST widely adopted in the UK. This raises awareness that the RST can underestimate overall surgical risk and may therefore inaccurately reflect mortality and morbidity risk. Knowledge of this incremental risk enabled clinicians to fully inform patients of their true cardio-respiratory risk associated with surgery. This transparency increased patient confidence in clinicians and the service, strengthening the patient & clinician relationship. It also contributed to staff job satisfaction and improved well-being and mental health. In some cases, incremental risk led to multi-disciplinary team’s decision to consider alternative options, which improved overall patient safety. Teamwork, morale and collaboration were further strengthened through this streamlined service. Conclusions The established pathway in pre-assessment identified patients who required respiratory assessment. This process highlighted 18 (11%) patients with an incremental risk associated with surgery from a respiratory standpoint- not captured by the standard RST used in the UK- thereby revealing a higher overall risk of mortality and morbidity. Identifying this risk facilitated creation of bespoke treatment plans and strategies to manage surgical risk more effectively. Patient safety, confidence, clinical decision making, and team morale were all improved through this specialized nurse-led respiratory assessment pathway. References Madden, A., Bowles, C., Norton, H., Alarilla, V., Zafar, M., Madden, B. P., (2025). The Expanding Role of Nurse-led Pre-operative Clinics for Respiratory Assessment, Management, and Optimisation of Elective Cardiac Surgical Patients. American Journal of Respiratory and Critical Care Medicine. 211. A2982. This abstract is funded by: Cardiothoracic Department, St George’s University Hospitals NHS Foundation Trust