Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs
We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. A prospective study. Queen Elizabeth Hospital, Barbados. Participants comprised all patients undergoing general, epi...
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| Vydané v: | Journal of clinical anesthesia Ročník 35; s. 176 - 189 |
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| Jazyk: | English |
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Elsevier Inc
01.12.2016
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| Abstract | We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices.
A prospective study.
Queen Elizabeth Hospital, Barbados.
Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required.
Introduction of formal guidelines for preoperative investigations.
The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments.
For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications.
Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.
•The introduction of guidelines has resulted in some beneficial changes in practice.•There was a decrease in the numbers of tests done in the younger age groups.•The significant improvements were noted only with full blood count and chest x-ray.•Introduction of guidelines resulted in savings of US $40,745.50 per year. |
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| AbstractList | STUDY OBJECTIVEWe endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices.DESIGNA prospective study.SETTINGQueen Elizabeth Hospital, Barbados.PATIENTSParticipants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required.INTERVENTIONIntroduction of formal guidelines for preoperative investigations.MEASUREMENTSThe patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments.MAIN RESULTSFor younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications.CONCLUSIONOur findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety. We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. A prospective study. Queen Elizabeth Hospital, Barbados. Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. Introduction of formal guidelines for preoperative investigations. The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety. •The introduction of guidelines has resulted in some beneficial changes in practice.•There was a decrease in the numbers of tests done in the younger age groups.•The significant improvements were noted only with full blood count and chest x-ray.•Introduction of guidelines resulted in savings of US $40,745.50 per year. Abstract Study Objective We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. Design A prospective study. Setting Queen Elizabeth Hospital, Barbados. Patients Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. Intervention Introduction of formal guidelines for preoperative investigations. Measurements The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. Main Results For younger patients (<60 years), the mean number of tests decreased from 3.42 ± 1.8 in the preguideline group to 2.89 ± 1.98 in the postguideline group ( P = .042). The total number of chest x-rays decreased by 14.8% ( P = .012) and full blood counts by 7.6% ( P = .036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. Conclusion Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety. Study Objective We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. Design A prospective study. Setting Queen Elizabeth Hospital, Barbados. Patients Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. Intervention Introduction of formal guidelines for preoperative investigations. Measurements The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. Main Results For younger patients (<60 years), the mean number of tests decreased from 3.42 plus or minus 1.8 in the preguideline group to 2.89 plus or minus 1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. Conclusion Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety. We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. A prospective study. Queen Elizabeth Hospital, Barbados. Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. Introduction of formal guidelines for preoperative investigations. The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety. |
| Author | Nicholls, Judith Gaskin, Pamela S. Areti, Yasodananda K. Ward, Justin |
| Author_xml | – sequence: 1 givenname: Judith surname: Nicholls fullname: Nicholls, Judith email: judith.l.nicholls@gmail.com organization: Department of Anaesthesia, Queen Elizabeth Hospital, Martindales Road, St Michael, Barbados – sequence: 2 givenname: Pamela S. surname: Gaskin fullname: Gaskin, Pamela S. organization: Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados – sequence: 3 givenname: Justin surname: Ward fullname: Ward, Justin organization: Faculty of Science and Technology, The University of the West Indies, Cave Hill, Barbados – sequence: 4 givenname: Yasodananda K. surname: Areti fullname: Areti, Yasodananda K. organization: Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27871517$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_bpa_2020_04_006 crossref_primary_10_1097_AAP_0000000000000702 crossref_primary_10_7759_cureus_57448 crossref_primary_10_1186_s13643_020_01404_8 crossref_primary_10_1002_aorn_14188 crossref_primary_10_1007_s40140_020_00371_z |
| Cites_doi | 10.4038/slja.v18i1.1558 10.4103/0970-9185.81824 10.1177/0310057X9902700508 10.1136/bmj.307.6907.793 10.1097/00003643-200308000-00004 10.1007/BF03015765 10.1046/j.1365-2044.2002.02750.x 10.1046/j.1525-1497.1999.00308.x 10.1177/0310057X0203000310 10.1378/chest.115.suppl_2.96S |
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| Copyright | 2016 Elsevier Inc. Elsevier Inc. Copyright © 2016 Elsevier Inc. All rights reserved. Copyright Elsevier Limited Dec 2016 |
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| SubjectTerms | Adaptation Adult Aged Anesthesia Anesthesia & Perioperative Care Anesthesia - economics Anesthesia - methods Anesthesia - standards Cost Cost analysis Cost control Cost-Benefit Analysis Data collection Diagnostic Tests, Routine - economics Diagnostic Tests, Routine - standards Elective surgery Elective Surgical Procedures - economics Elective Surgical Procedures - standards Electrocardiography Female Guideline Guideline Adherence - economics Hospitals - standards Humans Laboratories Male Medical personnel Middle Aged Outcome and Process Assessment (Health Care) Pain Medicine Patient Safety Practice Guidelines as Topic Preoperative Care - economics Preoperative Care - standards Preoperative investigation Prospective Studies Questionnaires Surgery Young Adult |
| Title | Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs |
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| Volume | 35 |
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