[Routine preoperative testing: Impact of implementation of local recommendations in a teaching hospital]

to compare the number and the cost of preoperative tests ordered before scheduled surgery before and after implementation of local guidelines.

observational retrospective survey.

All patients scheduled in seven surgical specialties.

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).

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.

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.