Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes and costs

OBJECTIVES: Patients who present for elective surgery are often subjected to routine preoperative investigations, which often lead to unnecessary costs, delays or cancellation of surgery. We assessed the current practices, and the impact of guidelines for preoperative investigations on outcomes, practices and costs. DESIGN AND METHODS: The patterns of preoperative testing were assessed by conducting an audit. Preoperative investigation guidelines developed were presented to all surgical departments. The audit was repeated post-intervention compared to the pre-guideline audit. RESULTS: A total of 304 patients (150 before and 154 after) was included. The mean number of tests per patient did not significantly change between the pre-guideline and post guideline groups. For younger patients (under 60 years), the mean number of tests decreased from 3.42 ± 1.8 in the pre-guideline group to 2.89 ± 1.98 in the post guideline group (p=0.042). The total number of Chest X-rays decreased by 14.8% (p=0.012) and of Full blood counts (FBC) by 7.6% (p=0.036). For the remainder of investigations, there was no difference. The implementation of changes lead to overall savings of $15,178 per 1000 patients ($81,491 BDS per annum). The most notable savings are due to decreased number of Chest X-Rays. CONCLUSIONS: This study demonstrated that preoperative investigations were performed as a routine even in the absence of any clinical indication. The introduction of guidelines for preoperative investigations significantly decreased costs to the institution without compromising the safety of patient care and without placing patients at risk.