OBJECTIVE: to compare the number and the cost of preoperative tests ordered before scheduled surgery before and after implementation of local guidelines.STUDY DESIGN: observational retrospective survey.PATIENTS: All patients scheduled in seven surgical specialties.METHODS: all preoperative tests ordered during a 1-week period (2008) were noted. Local guidelines based on published guidelines and validated by anesthesiologists of the hospital were then implemented. A second audit was performed 1 year after (2009).RESULTS: Eighty-five and 79 patients' files were analyzed in 2008 and 2009, respectively. On average, half (46% in 2008 and 58% in 2009) of prescriptions did not follow the guidelines, with anaesthesiologists prescribing more than their own recommendations. Overall conformity to the local guidelines did not improve between 2008 and 2009. However, EKG (79% vs. 95%, p<0.05) and serum electrolytes (72% vs. 99%, p<0.05) ordered were significantly in better agreement with the guidelines. Costs associated with inadequate orders were divided by 2.4 in 2009.CONCLUSIONS: existing practice is overall poor. Non-compliance of preoperative testing to guidelines is a significant cause of uncontrolled cost. Change in compliance is a slow process.
Diagnostic Tests, Routine Guideline Adherence