Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests

Abstract

P Pu ur rp po os se e: : Preoperative investigations are frequently ordered according to care maps or protocols. We hypothesized that selective ordering of investigations by anesthesiology staff would reduce the number and cost of testing.M Me et th ho od ds s: : Prospective descriptive double cohort study carried out over 17 weeks in a tertiary care preadmission clinic. In Group 1, testing followed usual practice (based on standing preoperative orders) while in Group 2 testing was initiated only on the order of an attending anesthesiologist or anesthesiology resident. Postoperative complications were categorized and confirmed by an internist blinded to group assignment. Fisher's exact test, Chisquare and Student's t test were used to compare the groups as appropriate. Statistical significance was inferred at P < 0.05. R Re es su ul lt ts s: : Data were obtained from 507 patients in Group 1 and 431 patients in Group 2. Demographics and ASA risk score were similar in both groups. The mean number of tests ordered did not differ between groups. The mean cost of investigations was reduced from $124 in Group 1 to $95 in Group 2 (P < 0.05). If data for patients assessed by staff anesthesiologists only were considered, the mean cost of testing was reduced to $73. The number and cost of tests ordered by anesthesia residents were similar to that in Group 1. More complications were noted in Group 2, but these did not appear to be related to the altered test ordering practice.C Co on nc cl lu us si io on n: : Selective test ordering by staff anesthesiologists reduces the number and cost of preoperative investigations. Educational efforts should be directed towards improving resident and staff preoperative test ordering practices. HE routine ordering of screening laboratory and radiological investigations prior to surgery has been the subject of considerable criticism, resulting in the development of guidelines, 1-3 computer programs 4 and procedure/disease based algorithms to guide test selection. 5,6 The latter are usually institution or region specific and are incorporated into clinical pathways or care maps designed to standardize pre-and postoperative management of elective surgical patients. Objectif 6Clinical pathways have proven to be cost effective, reducing laboratory and diagnostic charges without adversely affecting outcome.7 In many situations, particularly where the patient is healthy or the procedure is relatively non-invasive, no preoperative investigations are performed. 8In parallel with these developments, surgical preoperative assessment clinics have been established which obviate the need for hospital admission prior to the day of surgery.9 This process has proven to be cost-effective and well accepted by patients.10 Preadmission clinics are frequently not staffed by physicians but by nurses who function in a screening role, detecting medical or physical conditions that trigger an anesthesiology or internal medicine consultation.11,12 Indeed, even in clinics where patients are assessed preoperatively by...

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

“…La seguridad del paciente no radica en si está hospitalizado o es ambulatorio. La seguridad es una actitud y cuando se siguen buenos principios de selección del paciente por el cirujano, con una buena evaluación preanestésica, no hay motivo para esperar más complicaciones que en pacientes hospitalizados (20). Son necesarios estudios epidemiológicos y clínicos por servicios individualizados para analizar la morbimortalidad anestésico-quirúrgica en España, especialmente en las unidades monográficas por patologías, edad y procedimientos.…”

Adopting Information Management Based Joint Preoperative Assessment and Risk Stratification Model to Save Surgical Care Cost

“…It has been found that most of the patients who attend preanesthesia clinic (PAC) for preoperative evaluation, risk assessment and stratification had already undergone majority of the tests on the very first contact with surgeon [9,14] . Studies also have shown that tests ordered by the anesthesiologists are more in compliance to the guidelines or recommendations than those ordered by the surgeons for preoperative evaluation [9,15] . So involvement of surgical discipline (by not ordering routine preoperative tests) is very much essential for reducing this unnecessary cost burden on patients, institution and nation.…”

Reference Guidelines Improve Residents? Ability to Order Appropriate Preoperative Tests in Standardized Case Scenarios

“…Consequently, many patients are not evaluated by an attending anesthesiologist at all prior to surgery. It has been estimated that greater than 50% of patients do not visit a preadmission testing center, even though these have been showed to be efficient and costeffective [1][2][3][4][5][6][7][8][9]. Preoperative testing for surgery is estimated to account for approximately $30 billion in health care costs annually in the US and a majority of these tests may be unnecessary [10][11][12].…”