Telephone pre-operative assessment for adults: a comprehensive systematic review

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Executive summaryBackgroundThe preparation of the patient for surgery is an extremely important stage of the elective perioperative process. Telephone preoperative assessment is being used internationally as a tool to perform health screening. The evidence around the effectiveness of such an intervention and the patient's experience of preoperative screening has not, however, been examined.Objectives:Is telephone preoperative assessment as effective as face-to-face preadmission clinic visits on adult patient preparedness for elective surgery?What are the perioperative experiences of adult patients who have received telephone- based preoperative preparation for elective surgery?Inclusion criteriaTypes of studiesThis review considered quantitative and qualitative studies that examined the effectiveness of telephone preoperative assessment and the experiences of adult elective ambulatory and inpatient surgery patients receiving this intervention.Types of participantsThe participants in the review were adult patients, having elective surgery in a hospital setting, and who had experienced a telephone preoperative consultation.Types of intervention(s)/phenomena of interestStudies that examined the effectiveness and meaningfulness of telephone preoperative assessment for adults were considered for inclusion in this systematic review.Types of outcomesThe review explored evidence on outcome measures related to the patient preparation for surgery and also to the experiences of patients who have had telephone preoperative assessment.Search StrategyA three phase search strategy was utilised. A limited search of systematic reviews and PubMed database was conducted. Search strategies were developed using identified key words and index terms across multiple databases and grey literature and reference lists of identified articles were examined. Searches were limited to studies published in English between 2000 and May 2011.Methodological qualityThe studies were independently assessed by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute.Data ExtractionQuantitative data were extracted using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument data extraction tool. Qualitative data were extracted using the Joanna Briggs Institute Qualitative Assessment Review Instrument data extraction tool.Data SynthesisStatistical pooling was not possible due to the nature of the quantitative study designs, therefore the findings of this review are presented in narrative form. Only one qualitative paper was included therefore findings are presented in narrative form.ResultsTwelve studies were included in the review. From the available evidence it was found that telephone assessment may be as effective as face-to-face preadmission clinic visits in terms of preparing the patient for elective surgery, reducing the rate of last minute theatre cancellations and in the reduction of anxiety levels. Only one study reported the patient experiences of this intervention.ConclusionsThis review demonstrated that telephone preoperative assessment may be a viable option for practice in terms of effectiveness. There is a paucity of literature regarding the patient experiences of the intervention.Implications for practiceTelephone preoperative assessment may be an effective alternative to face-to-face assessment, resulting in reduction of cancellations and postponements and reduction of anxiety in preoperative patients.Implication for researchCurrently the overall level of evidence regarding telephone-based preoperative assessment is low; more rigorous studies are required for all of the examined outcomes.

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