title: How to rationalize preoperative tests? A method to implement local guidelines successfully.
abstract: BACKGROUND
  Preoperative screening includes clinical examination and tests. Systematic prescription leads to excessive tests. We conducted an observational retrospective study to assess the success of implementing a protocol-guided prescription procedure for preoperative tests (PTs). We compared the number of PTs prescribed for scheduled surgery before and after the implementation of local guidelines with a specific method.
  
  
  METHODS
  Local guidelines for prescribing PTs based on the French Society of Anaesthesia's recommendations were developed, validated by the anaesthesia team and actively implemented. The implementation procedure was complex and based on the application of sociologic concepts to facilitate PT prescriptions in accordance with the protocol. All PTs (except for children and emergency surgeries) prescribed over a one-week observation period were analysed before and after protocol implementation, respectively in 2011 and 2013.
  
  
  RESULTS
  Two hundred and ninety-two patient files were analysed: 157 in 2011 and 135 in 2013. Ninety-one percent of the prescriptions were in accordance with the recommendations in 2013. Excessive prescribing decreased significantly after the implementation of recommendations (7.1% versus 20.7%, P<0.0001), enabling us to reduce excess costs.
  
  
  CONCLUSIONS
  We observed excellent adherence to the prescription protocol for PTs. The method used to implement the protocol was successful. A future evaluation should be undertaken to confirm these results over the long-term.
authors.affiliation: Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France. Electronic address: stephanie.suria@gustaveroussy.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Suria
authors.affiliation: Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France. Electronic address: hakimharkouk@hotmail.fr.
authors.forename: Hakim
authors.initials: H
authors.lastname: Harkouk
authors.affiliation: Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France. Electronic address: alexandre.eghiaian@gustaveroussy.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Eghiaian
authors.affiliation: Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France. Electronic address: gregoire.weil@gustaveroussy.fr.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Weil
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D005260:Female; D005602:France; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000592:standards*; D055656:Prescriptions; D012189:Retrospective Studies
keywords: Anaesthesia audit; Audit; Pre-anaesthesia assessment