An Audit of the Preoperative Investigation of Surgical Patients

Abstract

The pattern of preoperative investigation was audited in 256 patients entering hospital for elective surgery over a 12-week period. During the initial 6 weeks (phase one), no tests are relevant and to minimise unnecessary expenditure. Methods and patientsThe pattern of requests of the five most commonly performed investigations was examined. The investigations were: full blood count (FBC), urea and electrolytes (U&E), blood glucose, chest radiograph (CR) and electrocardiogram (ECG). In phase one of the study, the established practice in requesting these preoperative investigations was analysed. All patients admitted to the hospital for elective surgery over a 6-week period under the care of the four general surgeons were studied. Patients undergoing day-case surgery and emergencies were excluded. The preoperative investigations performed on each patient were recorded on the evening of surgery; each investigation was documented as normal or abnormal and it was recorded whether an abnormal result had induced an alteration in clinical management. Each investigation was then classified as being either 'indicated' or 'not indicated' according to criteria derived from the literature (1-6).

Effective strategy to guide pathology test ordering in surgical patients

“…The planning phase involved regular meetings of the Royal North Shore Hospital surgical team that consisted of a consultant surgeon and anaesthetist, junior medical officers, PAC nurse screener, and quality manager. An initial audit of 20 randomly selected medical records of patients who had attended the PAC confirmed that >40% of tests ordered were inappropriate, a finding consistent with previous reports 4 .…”

Role of coagulation testing in predicting bleeding risk

“…[13][14][15] Furthermore, most studies of mass screening tests report that 30-95% of unexpected laboratory abnormalities are not documented nor pursued using further investigations. 23,24 There are obvious implications in not pursuing unexpected abnormal results that could potentially increase rather than reduce legal liability. In addition, there is a perception that coagulation tests are inexpensive.…”

Evaluating Compliance with Institutional Preoperative Testing Guidelines for Minimal-Risk Patients Undergoing Elective Surgery

“…The sample size calculation was based on an expected incidence of compliant tests of 30% [1, 9] of the patients undergoing surgery; in order to obtain a 95% confidence interval (CI) of 5%, a sample of at least 1,291 subjects was required. However, the sample size was inflated by 15% due to incomplete information in records; therefore, 1,500 subjects were needed in this study.…”

“…The fundamental purposes of preoperative investigations are to obtain information regarding a patient's fitness for anesthesia and surgery and to assess the intraoperative risks [1–4]. Preoperative investigations were found to be beneficial and cost-effective when they had been correlated with the patients' histories and physical examinations.…”

“…Unfortunately, the application of the guidelines in clinical practice demonstrated a high failure rate in many reports. The proportion of patients who underwent at least one nonindicated test according to their institutional guidelines ranged from 60 to 90% [1, 9]. The types of common noncompliant tests were chest radiograph (CXR), electrocardiography (ECG), liver function test (LFT), and coagulogram [10, 11].…”