title: An audit of the cost effectiveness of protocol-driven versus surgeon-directed pre-operative assessment of NHS patients referred to a General Surgeon.
abstract: OBJECTIVE
  Pre-operative assessment (POA) is now commonplace and follows established protocols. This audit compares the cost-effectiveness of surgeon-directed (SD) POA compared to the standard practice of protocol-driven (PD) POA.
  
  
  METHODS
  One hundred and fifty-six NHS patients who were referred to a single surgeon during 2009 were allocated to one of three groups. Group 1: SDPOA required no investigations, whereas the PDPOA would have mandated only Methycillin-Resistant Staphylococcus aureus (MRSA) screening and urinalysis; Group 2: SDPOA required no pre-operative investigations, whereas the PDPOA would have required investigations to be performed; Group 3: SDPOA recommended selective investigations, PDPOA required additional tests. For each group the investigations requested and performed, their cost and whether the results affected patient care were recorded. There is no individual PDPOA group, but the cost of the extra tests was calculated where the PDPOA protocols were followed and therefore the cost differed between the SDPOA and PDPOA.
  
  
  RESULTS
  The total cost for all investigations for the 156 patients was pound 43,985. A potential cost saving of pound 9,694 (group 2) and pound 8,898 (group 3) was demonstrated. The total potential saving identified for all 3 groups was pound 18,592, which was 42% of the total cost of all the investigations. Patient care was not affected by these additional investigations.
  
  
  CONCLUSIONS
  There were no observed peri-operative complications during the study, implying that the additional pre-operative investigations were clinically unnecessary and identifying an additional cost saving of pound 18,592.
authors: Department of General Surgery, Plymouth, PL6 8DH.
authors: S D
authors: SD
authors: Woolley
authors: Nuffield Health, Plymouth, PL6 8BG.
authors: L
authors: L
authors: Walsh
authors: Department of General Surgery, Plymouth.
authors: A W
authors: AW
authors: Lambert
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D013222:State Medicine; D055815:Young Adult