title: Economic impact of clinical variability in preoperative testing for major outpatient surgery.
abstract: BACKGROUND
  With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients.
  
  
  METHODS
  A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol.
  
  
  RESULTS
  The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated.
  
  
  CONCLUSIONS
  Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care.
authors.affiliation: Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: christian.gilborrelli@gmail.com.
authors.forename: Christian Carlo
authors.initials: CC
authors.lastname: Gil-Borrelli
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Salomé
authors.initials: S
authors.lastname: Agustí
authors.affiliation: Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Pla
authors.affiliation: Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Alicia
authors.initials: A
authors.lastname: Díaz-Redondo
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Matilde
authors.initials: M
authors.lastname: Zaballos
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D003955:Diagnostic Tests, Routine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: Ambulatory surgical procedures; Costos de la atención de salud; Cuidados preoperatorios; Health care costs; Preoperative care; Procedimientos quirúrgicos ambulatorios