title: Implementation of national practice guidelines to reduce waste and optimize patient value.
abstract: The financial health care crisis has provided the platform to drive operational improvements at US health care facilities. This has led to adoption of lean operation principles by many health care organizations as a means of eliminating waste and improving operational efficiencies and overall value to patients. We believe that standardized implementation of national practice guidelines can provide the framework to help to reduce financial waste.
  
  
  
  We analyzed our institutional preoperative electrocardiogram (ECG) ordering practices for patients undergoing elective surgery at our institution from February-March, 2012 to identify utilization and review compliance with American Heart Association guidelines. We then implemented an ECG ordering algorithm based on these guidelines and studied changes in ordering patterns, associated cost savings and hospital billing for the same period in 2013.
  
  
  
  From February-March 2012, 677 noncardiac surgical procedures were performed at our institution, and 312 (46.1%) had a preoperative ECG. After implementation of our evidence-based ECG ordering algorithm for the same period in 2013, 707 noncardiac surgical cases were performed, and 120 (16.9%) had a preoperative ECG. Preoperative ECG utilization dropped 63% with an annual institutional cost savings of $72,906 and $291,618 in total annual health care savings. Based on our data, US-wide implementation of our evidence-based ECG ordering algorithm could save the US health care system >$1,868,800,000 per year.
  
  
  
  Here, we demonstrate that standardized application of a national practice guideline can be used to eliminate nearly $2 billion per year in waste from the US health care system.
authors.affiliation: Center for Medical Innovation, University of Utah, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah. Electronic address: john.langell@hsc.utah.edu.
authors.forename: John T
authors.initials: JT
authors.lastname: Langell
authors.affiliation: Department of Anesthesia, University of Utah, Salt Lake City, Utah.
authors.forename: Amber
authors.initials: A
authors.lastname: Bledsoe
authors.affiliation: Center for Medical Innovation, University of Utah, Salt Lake City, Utah.
authors.forename: Sathya
authors.initials: S
authors.lastname: Vijaykumar
authors.affiliation: Department of Nursing, University of Utah, Salt Lake City, Utah.
authors.forename: Terry
authors.initials: T
authors.lastname: Anderson
authors.affiliation: Department of Nursing, University of Utah, Salt Lake City, Utah.
authors.forename: Ivy
authors.initials: I
authors.lastname: Zawalski
authors.affiliation: Department of Nursing, University of Utah, Salt Lake City, Utah.
authors.forename: Joshua
authors.initials: J
authors.lastname: Zimmerman
mesh_terms: D017046:Cost Savings / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D004562:Electrocardiography / Q000191:economics / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D014589:Utah
keywords: Electrocardiogram; Lean operations; Practice guidelines