Effectiveness of trained nurses in preoperative assessment

Editor—As a trial, the study by Kinley et al shows that trained nurses are (approximately) equivalent to house officers at the tasks of conventional preoperative assessment.1 The real question to be asked is why we persist with the ritual of preoperative assessment led by junior staff (of whatever professional discipline) at all. A decade ago, I and my colleages re-engineered preoperative preparation of patients and developed a system that has eliminated the ritual involvement of junior medical staff altogether.2 By using a system led and supervised by a consultant anaesthetist, the tasks of gathering clinical and related information about a patient can be achieved using a combination of methods, including questionnaires, collecting information from general practitioners and other specialists, and selective clinic visits where patients are seen by both nurses and anaesthetists. Thus prepared, patients arrive in hospital two to three hours before surgery, even for major cardiothoracic or vascular surgery. The system has become widespread in most major hospitals in Australia and New Zealand, where hospital practice is broadly similar to that in the United Kingdom. So why compare nurses to house officers? Surely nurses are better than that.