Key result
Distributing modified criteria for preoperative investigations significantly increased the percentage of indicated investigations from 53% to 90% (P < 0.001).
Why the study?
Does providing criteria guidance to house surgeons improve the appropriateness of preoperative investigations in elective surgery patients?
Observational (n=256)
Does providing criteria guidance to house surgeons improve the appropriateness of preoperative investigations in elective surgery patients?
Providing explicit criteria to house surgeons significantly improves the appropriateness of preoperative investigations and can lead to substantial cost savings.
Answers are grounded in this paper and cite their sources.
Should not yet change preoperative testing practice; leaves open confirmation of outcomes and costs in randomized trials.
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 guidance was given to the house surgeons and the investigations were assessed as being 'indicated' or 'not indicated' according to preset criteria. A total of 272 investigations was performed on 117 patients. Minor modifications were made to the criteria. At the beginning of the second 6-week period (phase two), the modified criteria were distributed to the house surgeons as a guide to preoperative investigation. During this time 308 investigations were performed on 136 patients. The number of investigations (excluding ECGs) that were available at the time of surgery rose significantly (P < 0.001) from 66% in phase one to 81% in phase two. The percentage of investigations deemed to have been indicated rose significantly (P < 0.001) from 53% in the first phase to 90% in the second phase. It is calculated that in practice 94% of the maximum possible savings of 7080 pounds could be achieved over the course of 1 year by implementing these criteria for preoperative investigations.
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Billings et al. (1994) conducted an observational in Elective surgery (n=256). Distribution of modified criteria for preoperative investigation vs. No guidance (phase one) was evaluated on Percentage of investigations deemed to have been indicated (p=< 0.001). Distributing modified criteria for preoperative investigations significantly increased the percentage of indicated investigations from 53% to 90% (P < 0.001).
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