Continuous improvement, quality control, and cost containment in clinical laboratory testing. Effects of establishing...

To develop guidelines for laboratory tests ordered before admission for elective surgery.

A seven-step continuous quality improvement process.

The Departments of Laboratory Medicine, Surgery, and Anesthesia of the University of Massachusetts Medical Center, a 384-bed, teaching, tertiary-care facility.

Core group of the Department of Laboratory Medicine and the Laboratory Medical Advisory Committee.

Guidelines were developed for laboratory tests ordered before elective surgery. They were divided into four major groups as well as by age and gender. After an intense educational effort, consent was obtained from the majority of surgeons, who agreed to delegate the ordering of tests to the nurses and anesthesiologists who examine patients before surgery.

Charts chosen at random by the medical records department for the period prior to implementation of guidelines were reviewed and compared with records 1 and 2 years later.

Reductions of 50% and 60% in the first and second years, respectively, in the overall number of tests ordered per patient were demonstrated. An improvement in the appropriateness of tests was also documented: 81% in the first year and 86% in the second year, compared with 65% appropriateness prior to implementation of guidelines. A 1-year savings of $66,981 and an overall 2-year savings of $75,995 were documented.

We have described an approach that involves a sustained educational effort and collaboration of nurses and physicians and have presented specific guidelines for preoperative testing. A major decrease in the number of tests ordered, an increase in their appropriateness, and marked fiscal savings were documented.