Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital

Area of Science:

• Medical Research
• Surgical Patient Care
• Healthcare Quality Improvement

Background:

• Preoperative investigations for elective surgery are often extensive.
• Unnecessary tests contribute to healthcare costs and potential patient harm.
• Standardized criteria for preoperative testing are lacking in many institutions.

Purpose of the Study:

• To quantify the extent of unnecessary preoperative investigations in elective surgical patients.
• To evaluate the impact of implementing guidelines and educational interventions on reducing these investigations.
• To audit the changes in investigation rates over time.

Main Methods:

• Developed guidelines for preoperative anesthetic investigations based on international criteria.
• Implemented a two-week audit of indicated vs. non-indicated tests for elective surgery patients.
• Disseminated guidelines and provided educational lectures to surgical and anesthesia departments.
• Repeated the audit six months after the intervention.

Main Results:

• The incidence of over-investigation decreased from 13.8% to 11.6% (P = 0.03).
• No significant increase in under-investigation was observed (0.7% vs. 1.0%; P = 0.2).
• The study demonstrated a reduction in unwarranted screening tests.

Conclusions:

• Protocols and ongoing education are effective in reducing unnecessary preoperative investigations.
• Standardized preoperative assessment can improve healthcare efficiency and patient care.
• Further implementation of evidence-based guidelines is recommended for elective surgical preparation.