Impact of new guidelines on physicians' ordering of preoperative tests

OBJECTIVE: To compare the number of preoperative tests ordered for elective ambulatory surgery patients during the a years before and the 2 years afte r the establishment of new hospital testing guidelines. MEASUREMENTS: The patterns of preoperative testing by surgeons and a medica l consultant during the 2 gears before and the 2 years after the establishm ent of new guidelines at one orthopedic hospital were reviewed. All tests o rdered preoperatively were determined by review of medical records. Preoper ative medical histories, physical examinations, and comorbidities were obta ined according to a protocol by the medical consultant (author). Perioperat ive complications were determined by review of intraoperative and postopera tive events, which also were recorded according to a protocol. MAIN RESULTS:A total of 640 patients were enrolled, 861 before and 279 afte r the new guidelines. The mean number of tests decreased from 8.0 before to 5.6 after the new guidelines (p = .0001) and the percentage decrease for i ndividual tests varied from 23% to 44%. Except for patients with more comor bidity and patients receiving general anesthesia, there were decreases acro ss all patient groups. In multivariate analyses only time of surgery (befor e or after new guidelines), age, and type of surgery remained statistically significant (p = .0001 for all comparisons). Despite decreases in surgeons ' ordering of tests, the medical consultant did not order more tests after the new guidelines (p = .60). The majority of patients had no untoward even ts intraoperatively and postoperatively throughout the study period, with o nly 6% overall requiring admission to the hospital after surgery, mainly fo r reasons not related to abnormal tests. Savings from charges totaled $34.0 00 for the patients in the study. CONCLUSIONS:Although there was variable compliance among physicians, new ho spital guidelines were effective in reducing preoperative testing and did n ot result in increases in untoward perioperative events or in test ordering by the medical consultant.