How to

Please follow the instructions below on how to use the Pre-op Tool to determine what investigations are recommended by NICE in your patient(s).

Step One: enter patient details

1. Enter the patient’s full name, date of birth, and hospital number (or NHS number). These details are not stored anywhere, and are only used to help identify the patient on the results page which will be generated later.

2. If you do not want to give the patient’s details you can select the “Confidential” button. If you do this a separate box will appear where you can enter the patient’s age. This is required for determining what results are needed.

Step Two: choose patient’s co-morbidities

1. Please tick all relevant cardiovascular, respiratory, or renal co-morbidities for the patient. These are usually documented in the patient’s notes or GP electronic records.

2. Once you select a co-morbidity you must then choose how severe it is for the patient. This will determine the ASA grade for the particular co-morbidity.

3. If you have made a mistake and want to change the co-morbidity you can click on the ticked box and it will be unselected. If you have made a mistake with the severity of the co-morbidity this can simply be changed by choosing another option.

Step Three: choose grade of surgery

1. If you know the grade of surgery you can choose it from the drop down box available on the webpage.

2. If you are not sure of the grade of surgery you can refer to a sample of surgical grades created by NICE to help you determine the severity grade.

3. If you are still unsure or wish to simply choose your operation you can do this by simply choosing the specialty and then the surgery from the two drop down boxes. This will use a pre-set surgical grade for the operation as extrapolated by a consensus between the site authors. Please note that the “Grade of Surgery” drop down box must be set to “Grade” or “Unknown” for you to use this alternative selection method.

4. Another way to choose the operation is to simply type the name in the search bar provided. The autocomplete function will generate a live search result list. You can choose from the search results given at any time.

5. If you haven’t found the operation you want through the search bar, you can delete all your search text to make the other options for determining the grade of surgery active again.

Step Four: submitting data

1. Once you have gone through steps 1-3 quickly glance over the entered data to check that it is correct. Once you submit these details, you will not be able to go back and edit them. Instead, you will have to reenter them all over again, so it is important that you have not made any errors.

2. After you have checked all your entries click the “Submit” button at the bottom of the page.

Step Five: results

1. Once all the patient details have been submitted you will be taken to a results page.

2. On the top half of the page you will find all the entered patients details. The demographic details are displayed on the left hand side and the medical co-morbidities and surgical details are displayed on the right.

3. The ASA grade shown is calculated from the severity of the co-morbidities you have chosen and is displayed for your benefit. Note that only ASA grades 1-3 are considered by NICE guidelines (2003) as people with an ASA grade higher than this are usually not considered fit for routine elective surgery.

4. If you have selected an operation rather than a grade of surgery in step three, the corresponding pre-assigned grade of surgery for your selected operation will be shown with the patient details.

5. The second half of the results page will contain a table of nine investigations. On the left column of the table you will find the names of the investigations and in the right column you will find whether or not the test is recommended, should be considered, or is not recommended in routine pre-operative assessment for your patient.

6. The categories of recommended, consider, and not recommended are displayed with corresponding coloured boxes in green, yellow, and red respectively. These allow for a quick visual guage of the tests advised in addition to the text recommendations.

Disclaimer: Please note that the Pre-op Assessment Tool simple generates a summary of recommendations for nine common pre-operative tests based on particular patient and surgery details as outlined by NICE (2003). There are may be other tests and specialists reviews that may become necessary in the course of pre-operative assessment and these should be dealt with appropriately by the healthcare professional involved. There may be other co-morbidities in patients that warrant routine tests such as a full blood count even when the NICE guidance does not advise so (e.g. known anaemia). In such cases, pre-op tests should be performed based on a patient’s individual past medical history. The NICE guidance functions only as a reference tool for patient’s who may not otherwise have any known indication for certain preop tests.

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