Abstract
Purpose
Preoperative investigations are frequently ordered according to care maps or protocols. We hypothesized that selective ordering of investigations by anesthesiology staff would reduce the number and cost of testing.
Methods
Prospective descriptive double cohort study carried out over 17 weeks in a tertiary care preadmission clinic. In Group 1, testing followed usual practice (based on standing preoperative orders) while in Group 2 testing was initiated only on the order of an attending anesthesiologist or anesthesiology resident. Postoperative complications were categorized and confirmed by an internist blinded to group assignment. Fisher’s exact test, Chisquare and Student’s t test were used to compare the groups as appropriate. Statistical significance was inferred atP < 0.05.
Results
Data were obtained from 507 patients in Group 1 and 431 patients in Group 2. Demographics and ASA risk score were similar in both groups. The mean number of tests ordered did not differ between groups. The mean cost of investigations was reduced from $124 in Group 1 to $95 in Group 2 (P < 0.05). If data for patients assessed by staff anesthesiologists only were considered, the mean cost of testing was reduced to $73. The number and cost of tests ordered by anesthesia residents were similar to that in Group 1. More complications were noted in Group 2, but these did not appear to be related to the altered test ordering practice.
Conclusion
Selective test ordering by staff anesthesiologists reduces the number and cost of preoperative investigations. Educational efforts should be directed towards improving resident and staff preoperative test ordering practices.
Résumé
Objectif
Les tests préopératoires sont souvent demandés pour satisfaire à des plans thérapeutiques ou à des protocoles. Nous avons émis l’hypothèse qu’une demande sélective de tests par les anesthésiologistes réduirait le nombre et le coût de ces tests.
Méthode
Une étude prospective et descriptive de deux cohortes a été menée pendant 17 semaines dans une clinique de soins tertiaires. Dans le groupe 1, le protocole habituel a été suivi (fondé sur les règlements) tandis que dans le groupe 2, les tests ont été faits seulement sur ordre d’un anesthésiologiste traitant ou d’un résident en anesthésiologie. Les complications postopératoires ont été catégorisées et confirmées par un interniste impartial. Le test exact de Fisher, les tests du x2 et t de Student ont servi à comparer les groupes. Une signification statistique était considérée pourP < 0,05.
Résultats
Les données ont été obtenues de 507 patients dans le groupe 1 et de 431 dans le groupe 2. Les données démographiques et la cotation des risques selon l’ASA, de même que le nombre de tests demandés étaient similaires dans les deux groupes. Le coût moyen des tests a été réduit de 124 $ dans le groupe 1 à 95 $ dans le groupe 2 (P < 0,05). En ne tenant compte que des données évaluées par les anesthésiologistes traitants, le coût moyen était réduit à 73 $. Le nombre et le coût des tests demandés par les résidents étaient similaires à ceux du groupe 1. Il y a eu plus de complications dans le groupe 2, mais elles ne semblaient pas reliées à une modification de la demande de tests.
Conclusion
La demande sélective de tests par les anesthésiologistes traitants réduit le nombre et le coût des tests préopératoires. Il faudrait accentuer les efforts de formation visant à améliorer la pratique de demande de tests préopératoires par les résidents et le personnel traitant.
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Attribution: Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Supported by: Departmental funding.
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Finegan, B.A., Rashiq, S., McAlister, F.A. et al. Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Can J Anesth 52, 575–580 (2005). https://doi.org/10.1007/BF03015765
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DOI: https://doi.org/10.1007/BF03015765