title: Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs.
abstract: OBJECTIVE
  We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Queen Elizabeth Hospital, Barbados.
  
  
  METHODS
  Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required.
  
  
  METHODS
  Introduction of formal guidelines for preoperative investigations.
  
  
  METHODS
  The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments.
  
  
  RESULTS
  For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications.
  
  
  CONCLUSIONS
  Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.
authors.affiliation: Department of Anaesthesia, Queen Elizabeth Hospital, Martindales Road, St Michael, Barbados. Electronic address: judith.l.nicholls@gmail.com.
authors.forename: Judith
authors.initials: J
authors.lastname: Nicholls
authors.affiliation: Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Gaskin
authors.affiliation: Faculty of Science and Technology, The University of the West Indies, Cave Hill, Barbados.
authors.forename: Justin
authors.initials: J
authors.lastname: Ward
authors.affiliation: Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados.
authors.forename: Yasodananda K
authors.initials: YK
authors.lastname: Areti
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000191:economics / Q000379:methods / Q000592:standards*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000592:standards*; D017558:Elective Surgical Procedures / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000191:economics*; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000191:economics / Q000592:standards*; D011446:Prospective Studies; D055815:Young Adult
keywords: Cost; Elective surgery; Guideline; Preoperative investigation