Implementation and Validation of Decision-Aid Tool to Reduce Unnecessary Testing Before Thoracic Surgery

Area of Science:

• Anesthesiology and Perioperative Medicine
• Health Services Research
• Medical Informatics

Background:

• Preoperative type and screen tests (preT&S) are often overused in elective surgery.
• A validated decision-aid tool can optimize preT&S ordering.
• Reducing unnecessary tests can decrease healthcare costs.

Purpose of the Study:

• To implement and prospectively validate a decision-aid tool for guiding preT&S orders.
• To assess the tool's impact on testing rates, transfusion rates, and costs.
• To evaluate the accuracy of the decision-aid tool in predicting the need for preT&S.

Main Methods:

• An interrupted time-series quasi-experimental study was conducted at an academic institution.
• A previously published nomogram predicting preT&S need was implemented for elective thoracic surgery patients.
• Data was collected before and after implementation, with validation using logistic regression, c-index, and predictive values.

Main Results:

• The decision-aid tool significantly reduced preT&S ordering from 94.4% to 60.2% (p<0.001).
• Transfusion rates remained similar between groups (6.8% vs 6.7%).
• The tool demonstrated high accuracy (c-index 0.977, 100% sensitivity, 90.3% specificity) and generated $25,048 in cost savings over 6 months.

Conclusions:

• The decision-aid tool is feasible, accurate, and effective in reducing unnecessary preT&S in elective thoracic surgery.
• Implementation leads to significant cost savings.
• Wider adoption of this tool can yield substantial financial benefits in preoperative testing.