title: Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital.
abstract: OBJECTIVE
  To describe the effect of local adaptation of national guidelines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics.
  
  
  METHODS
  Assessment of preoperative tests ordered over one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis.
  
  
  METHODS
  Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France.
  
  
  METHODS
  42 anaesthetists, 60 surgeons, and their teams.
  
  
  METHODS
  Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings.
  
  
  RESULTS
  Of 536 patients at low risk from anaesthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied in 1994 after the intervention only 48% had one or more preoperative tests ordered (p < 0.05). Estimated mean (SD) saving for one year if changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF.
  
  
  CONCLUSIONS
  A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change.
authors.affiliation: University of Bordeaux II, Bordeaux Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Capdenat Saint-Martin
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.forename: J M
authors.initials: JM
authors.lastname: Raymond
authors.forename: H
authors.initials: H
authors.lastname: Iskandar
authors.forename: C
authors.initials: C
authors.lastname: Chevalier
authors.forename: M N
authors.initials: MN
authors.lastname: Petitpierre
authors.forename: L
authors.initials: L
authors.lastname: Daubech
authors.forename: M
authors.initials: M
authors.lastname: Amouretti
authors.forename: P
authors.initials: P
authors.lastname: Maurette
mesh_terms: D000761:Anesthesia Department, Hospital / Q000191:economics / Q000592:standards*; D000777:Anesthetics / Q000009:adverse effects*; D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D005602:France; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D012307:Risk Factors; D012985:Software Design