Comparison of selection of preoperative laboratory tests: the computer vs the anaesthetist

HealthQuiz II (HQII) is a computerized history-taking device which can be used by patients before anaesthesia and surgery. HealthQuiz II provides a summary of symptoms, a modified ASA Classification, and a list of suggested laboratory tests. Developed at the University of Chicago, the device has not been evaluated in Canada. The purpose of this study was to compare preoperative evaluation and selection of laboratory tests by a group of Canadian anaesthetists using traditional methods versus using HealthQuiz II. Twenty-seven anaesthetists from three (Western) Canadian University teaching hospitals participated in the study. The subjects were male, aged between 30-50 yr, trained in Canada and practicing in Calgary, Edmonton and Vancouver. They were asked to self-evaluate and select laboratory tests and then to complete the HQII protocol, the day before a proposed mock operation. Results of this comparison showed that the ASA scores assigned by HQII were higher for 11 subjects and lower for two. Eight anaesthetists thought HQII asked questions which they omitted while five thought HQII overlooked items. Thirteen anaesthetists believed HQII would be a useful adjunct to their practice. Only ten anaesthetists requested any tests while HealthQuiz II suggested tests for 23 subjects, with an average of 1.9 tests/subject (anaesthetists) vs 5.4 tests/subject (HQII). The total cost of tests selected by anaesthetists was $272.15 in contrast with $1,513.20 for those suggested by HQII. We conclude that rationale for test selection may have contributed to the difference in number and costs of tests.