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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Veröffentlicht in:Journal of clinical anesthesia Jg. 35; S. 176 - 189
Hauptverfasser: Nicholls, Judith, Gaskin, Pamela S., Ward, Justin, Areti, Yasodananda K.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.12.2016
Elsevier Limited
Schlagworte:
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
Barbados
Preoperative investigation
Guideline
Elective surgery
Cost
ISSN:0952-8180, 1873-4529
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Zusammenfassung: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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ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2016.07.008