Factors affecting pre‐operative assessment times – a reply

I would like to thank Dr Dexter for his letter pointing out some previous research into the planning and scheduling of anaesthetic pre-operative assessment clinics that we did not find in our search 1. The online lecture facility referred to is well worth a visit for those interested in this topic. Our introduction was mainly intended to refer to clinical factors, although we did report our findings related to nurse practitioners and agree that focusing on individual practitioners is unlikely to result in any improved efficiency in preoperative assessment clinics. Gibby's paper from 1998 2 reported how missing patient data affected the pre-assessment time for patients attending a physician-led clinic, where the mean overall time (42.5 min) was similar to that found in our nurse-led clinic. This small study (n = 316) grouped patients into ASA 1/2 or ASA 3/4, and confirmed that the ASA 3/4 patients took longer to assess, as did those with missing data. The correspondent's previous papers referred to in his letter give some interesting insight into clinic planning. The paper from 1999 gives some good advice regarding allowing for factors such as non-attenders, poor punctuality of patients and encouraging non-tardiness of clinic staff, however the effect of the premorbid condition of the patient on appointment time was not addressed 3. In his paper from 2012, the author pointed out that ASA is usually unknown prior to an appointment and reported that the number of medications could be used as a surrogate marker of comorbidity and subsequently longer appointment, underlining our finding related to ASA status and age 4. We have now introduced ePAQ-Po, which is filled in by some patients before their appointment with a nurse 5, 6. This gives an estimate of ASA and will be used to screen patients not needing a detailed pre-assessment. Further work is needed to ascertain if it will save the clinician or nurse practitioners further valuable time at a subsequent face-to-face interview.