Pre-operative assessment (POA) has been advocated for use to achieve a number of goals including reducing cancelled operations on the day of surgery, and therefore waiting lists. POA has historically been provided by junior doctors, but the change in focus of their role in addition to the new roles being taken on by nurses has led to nurse-led POA. The aim of this review was to determine whether nurse-led POA reduces the cancellation rate of elective surgical in-patient procedures. The Cochrane Library, Medline, Cinahl and Embase databases were searched for systematic reviews, randomised control trials and cohort studies examining nurse-led POA. After applying inclusion criteria only four cohort studies were deemed to be suitable to be critically appraised. One study had no cancellations in either the doctor or nurse-led POA groups. Another study had low cancellation rates in the nurse-led POA group, but the control group was not suitably defined for adequate verification as to whether the cancellation rates were lower because they had been pre-assessed. The final two studies revealed similar absolute risk reductions, number needed to treat and odds ratios. In summary nurse-led POA appears to reduce cancellation rates on admission, but the evidence for this is relatively weak, primarily because study samples have been small. Further trials are needed which have samples that are sufficient to detect a true difference between the intervention and control group if one exists.

I was invited to write this article after I gave a talk about setting up a preoperative assessment clinic. If you're facing the daunting task of providing a new service in your primary or secondary care job I hope that you'll find something useful here. Before I begin I'll repeat the confession that I made when I gave my talk. I am not an expert. In fact I have had little experience setting up new clinics. What I have done here is distil the experience of colleagues from around the country with whom I have had the pleasure of talking. These are their words.

Objective: To investigate the completeness of documentation of anaesthetic charts in elective orthopaedic anaesthesia.

Design: Data collection from medical records.

Setting: Orthopaedic department, teaching hospital.

Participants: Anonymous anaesthetic consultants participating in orthopaedic surgery.

Intervention: E-mail and verbal message regarding 2nd data collection to anaesthetic colleagues.

Main outcome measures: Documentation of data of variables on anaesthetic chart.

Results: Good documentation of most variables. An average improvement of 5.7% in data documentation, range of −2.7% to 24.7%. Poor documentation of blood loss and urinary output.

Conclusions: The importance of the anaesthetic chart cannot be underestimated. A close working relationship with ones colleagues in anaesthesia promotes a fuller use of the chart and contributes to its continued development as a source of information.