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 OPPASS
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Out Patient Pre-Assessment System for Windows
Decision support system for nurses in routine pre-admission assessment of the fitness of patients for
elective surgery under general anaesthesia |
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| keywords |
clinical domains |
| Decision support systems, knowledge-based systems, patient preassessment |
Out-patient pre-assessment, nurse-led clinics, surgery, anaesthetic assessment, anaesthetic outpatient |
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| developed by |
Dr Peter Emerson (clinical director), Saki Hajnal (technical director), Dr Malcolm Duncan (front end, networking and other technical development work), Dr Peter Barnes (senior anaesthetist at Chelsea and Westminster Hospital, London)
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| location of use |
Chelsea and Westminster Hospital, London (1995-1999); the Pre-assessment Unit of the Hillingdon Hospital, Pield Field Road, Uxbridge, UB8 3NN, UK
since February 2001.
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| commissioned |
1995 - DOS version went live at Chelsea and Westminster Hospital, London;
1999 - OPPASS knowledge base programmed into the nursing assessment
module of Lastword at Chelsea and Westminster Hospital, London, where it continues in routine use;
2001 - Version 1 of OPPASS for Windows developed at The Hillingdon
Hospital, London;
2003 - Version 2 of OPPASS for Windows went live at The Hillingdon
Hospital, London.
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| status |
Version 2 is currently in
routine use on a network at The Hillingdon Hospital, London.
A number of implementations of OPPASS have been in use since 1995.
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| reasoning technology |
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| system information and/or access |
System not available online.
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| description |
The OPPASS system is designed to provide an
electronic questionnaire and clinical decision support to nurses carrying
out pre-operative assessments of out patients a few weeks prior to the
patients admission for elective surgery under general anaesthesia.
Oppass is a knowledge-based decision support system designed to support nurse-led assessment of the fitness of a patient
for elective (pre-planned) surgery
in order to reduce the risks of an operation under general anaesthetic.
OPPASS provides a structured branching logic for an on screen questionnaire completed by a nurse in the presence of the patient. Clinical rules programmed in the software process the data entered and generate:
- Printed Forms for Investigations (Haematology, Chemical pathology, Microbiology ...)
- A printed OPPASS Clinical Report (including nurse's observations and examination, assessment of infection risk, list of adverse findings requiring pre admission remedial action, advice on actions to be considered in response to the reported adverse findings ...)
- A printed Form for Results, Outcomes and Audit (including list of investigations awaiting results
adverse features and advice ...)
"While these documents are being printed the nurse briefs the patient on the clinical findings, the necessary investigations and the forthcoming admission. The recommended swabs, blood or urine samples are taken, any recommended ECG or X-ray is arranged and the patient goes home. Next day the nurse reviews the results of the investigations and, on the basis of these and the findings and advice of the OPPASS program, decides to allow the admission to proceed on schedule, to be suspended for a further intervention / other opinion, or to be cancelled."
OPPASS implements - and extends - guidelines
for pre-operative assessments of patients due for elective sugery published by the National Institute for Clinical Excellence (NICE) in the UK in 2003. The National Collaborating Centre for Acute Care (based at the Royal College of Surgeons of England) developed the guideline for NICE.
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| references |
Preoperative tests, the use of routine preoperative tests for elective surgery: evidence, methods and guidance - Full guideline.
Developed by the National Collaborating Centre
for Acute Care. June 2003.
[NICE]
[]
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Clinical guideline on the use of routine preoperative tests in elective surgery for children and adults.
From 'Background':
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Each year over three million operations are
performed in NHS hospitals. For many years it has
been usual practice in many hospitals to test
apparently healthy patients preoperatively for
unsuspected conditions that might affect their
treatment. Such investigations include chest x-rays,
haemostasis tests, blood glucose tests and sickle
cell tests.
The main purpose of preoperative investigations is
to provide additional diagnostic and prognostic
information to supplement the clinical history of
a patient with the aim of:
providing information that may confirm or
question the correctness of the current course
of clinical management;
using this information to reduce the possible
harm or increase the benefit to patients by
altering their clinical management if necessary;
using this information to help assess the risk
to the patient and opening up the possibility
of discussing potential increases of risk with
the patient;
predicting postoperative complications;
establishing a baseline measurement for later
reference (to refer back to postoperatively); and
opportunistic screening that is unrelated to
the surgery.
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Barnes PK, Emerson PA, Hajnal S, Radford WJ, Congleton J.
Influence of an anaesthetist on nurse-led, computer-based, pre-operative assessment.
Anaesthesia. 2000 Jun;55(6):576-80.
[PubMed]
[Blackwell]
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"
Trained nurses using a rule-based computer program can successfully carry out pre-anaesthesia screening. All medical problems and abnormal laboratory results need to be reviewed by an experienced anaesthetist. Following the introduction of this system, there was a reduction in the frequency of cancellations of patients from elective orthopaedic operating lists from 4.8% to 1.8%, a difference that was statistically significant (p = 0.03, CI = [0.6%, 5.5%]). To minimise cancellations from booked operating lists, a booked admissions policy is essential, so that the anaesthetist who will eventually be responsible for patients with medical problems can be identified. Cancellations cannot be avoided completely because some abnormal conditions arise or deteriorate after completion of the screening process. The anaesthetist responsible for the patient's anaesthetic may have different views of the risks involved from those of the anaesthetist undertaking the screening process.
"
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| acknowledgements |
| Peter Emerson, Saki Hajnal, Malcolm Duncan |
| page history |
Entry on OpenClinical: 08 November 2004
Last main update: 28 November 2004
Design - template v0.3: 24 June 2005. |
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OPPASS
oppass.co.uk