title: Quality improvement in preoperative assessment by implementation of an electronic decision support tool.
abstract: OBJECTIVE
  To evaluate the impact of the electronic decision support (eDS) tool 'PReOPerative evaluation' (PROP) on guideline adherence in preoperative assessment in statutory health care in Salzburg, Austria.
  
  
  METHODS
  The evaluation was designed as a non-randomized controlled trial with a historical control group (CG). In 2007, we consecutively recruited 1363 patients admitted for elective surgery, and evaluated the preoperative assessment. In 2008, PROP was implemented and available online. In 2009 we recruited 1148 patients preoperatively assessed using PROP (294 outpatients, 854 hospital sector). Our analysis includes full blood count, liver function tests, coagulation parameters, electrolytes, ECG, and chest x-ray.
  
  
  RESULTS
  The number of tests/patient without indication was 3.39 in the CG vs 0.60 in the intervention group (IG) (p<0.001). 97.8% (CG) vs 31.5% (IG) received at least one unnecessary test. However, we also observed an increase in recommended tests not performed/patient (0.05±0.27 (CG) vs 0.55±1.00 (IG), p<0.001). 4.2% (CG) vs 30.1% (IG) missed at least one necessary test. The guideline adherence (correctly tested/not tested) improved distinctively for all tests (1.6% (CG) vs 49.3% (IG), p<0.001).
  
  
  CONCLUSIONS
  PROP reduced the number of unnecessary tests/patient by 2.79 which implied a reduction of patients' burden, and a relevant cut in unnecessary costs. However, the advantage in specificity caused an increase in the number of patients incorrectly not tested. Further research is required regarding the impact of PROP on perioperative outcomes.
authors.affiliation: Institute of General Practice, Family Medicine and Preventive Medicine; Paracelsus Medical University, Salzburg, Austria. maria.flamm@donau-uni.ac.at
authors.forename: Maria
authors.initials: M
authors.lastname: Flamm
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fritsch
authors.forename: Martin
authors.initials: M
authors.lastname: Hysek
authors.forename: Sabine
authors.initials: S
authors.lastname: Klausner
authors.forename: Karl
authors.initials: K
authors.lastname: Entacher
authors.forename: Sigrid
authors.initials: S
authors.lastname: Panisch
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Soennichsen
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D020000:Decision Support Systems, Clinical; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D058996:Quality Improvement
keywords: clinical guideline; electronic decision support; implementation; preoperative assessment