If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Wrong standards
- Jon M Maskill (13 April 2008)
|
|
|||
|
Jon M Maskill, consultant anaesthetist Barnsley Hospital NHS FT
Send letter to journal:
|
I would like to congratulate Murthy, Lake and Fisher on their enlightening paper regarding selection of preoperative investigations (1). They demonstrated poor consensus (61%) between the 10 consultant anaesthetists selected as the reference standard. The OpCheck group used one of two SpRs in anaesthetics as their reference standard when comparing house officers with preassessment nurses. This was further complicated by a panel of consultants selected as final arbiters (2). These studies strengthen my belief that a much better reference standard would be whether the anaesthetist actually giving the anaesthetic does so without asking for further investigations. If the patient’s operation goes ahead without further tests then the preoperative investigation package could be considered as sensitive. Whether the anaesthetist takes into account all of the tests that are offered could be considered as a test of specificity. Anecdotally, anaesthetists are inconsistent in their requirements, occasionally insist on tests that they never look at, or ask for tests that make no difference to the way that they manage their patients. Whether they go ahead with an elective anaesthetic is a good test as to the completeness of preoperative investigations. In the absence of the anaesthetist who is actually going to be anaesthetising the patient, appropriately trained nurses and tools such as OSCAR offer far more consistency than third party medical staff when deciding on which tests should and should not be done. Jon Maskill FRCA Anaesthetic Preassessment Lead Barnsley 1. Evaluation of a decision support system to predict preoperative investigations. British Journal of Anaesthesia 2008 100(3):315-321 2. Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/ non- inferiority trial. British Medical Journal 2002; 325: 1323-28 Conflict of Interest:None declared |
|||