Impact of end user involvement in implementing guidelines on routine pre-operative tests

Area of Science:

• Medical Practice Guidelines
• Health Services Research
• Surgical Pre-operative Care

Background:

• Pre-operative testing in low-risk surgical patients often exceeds recommended guidelines.
• Inefficient testing increases healthcare costs and patient risk.
• Standardizing pre-operative test utilization is crucial for optimizing surgical pathways.

Purpose of the Study:

• To evaluate the effectiveness of a health professional-led implementation strategy for practice guidelines.
• To reduce the use of unnecessary pre-operative tests in elective surgery patients.
• To assess the impact on patient outcomes and healthcare resource utilization.

Main Methods:

• An observational, pre-post study design was employed across six hospitals.
• A 6-month implementation strategy involved local meetings with healthcare professionals.
• Multilevel logistic regression analyzed pre-operative test utilization in 17,978 patients before and after guideline adoption.

Main Results:

• Guideline adoption significantly reduced the probability of pre-operative tests: coagulation (81%), glycaemia (73%), azotaemia (62%), chest X-ray (57%), creatinemia (49%), and ECG (43%).
• These reductions resulted in substantial cost savings, amounting to 67,890 Swiss francs (US$42,000) in the final quarter.
• The odds ratios (OR) ranged from 0.19 to 0.57, indicating a strong association between guideline implementation and reduced testing.

Conclusions:

• Direct involvement of end-users in identifying barriers is effective for guideline implementation.
• This strategy successfully promoted the adoption of practice guidelines for pre-operative testing.
• The findings support a user-centered approach to improving clinical practice and reducing healthcare costs.