THE EFFECT OF DISSEMINATION OF RECOMMENDATIONS ON USE - PREOPERATIVE ROUTINES IN SWEDEN, 1989-91

The purpose of this study was to monitor changes in preoperative routi nes following recommendations given in 1989 by the Swedish Council on Technology Assessment and by the Swedish Consensus Conference on Preop erative Routines, both suggesting a more individualized utilization of preoperative testing. This was a multicenter, prospective, repetitive study conducted at seven Swedish hospitals providing surgical care. T he subjects included all patients presenting at the operating theaters for surgical interventions requiring general or regional anesthesia. The main outcome measures were the frequency of reports of performed p reoperative ECG, chest x-ray, and analysis of serum concentration of p otassium. Before general recommendations were issued in 1989, 47% of t he patients had had a preoperative ECG, 26% had had a chest x-ray, and in 61% serum potassium concentration had been measured. In 1991 these frequencies had been reduced by 5, 6, and 9 percentage points, respec tively (all figures given standardized for age and sex). Large differe nces were found between indidividual hospitals. Although recommendatio ns suggesting a more restrictive and individualized utilization of pre operative testing have sparked important revisions in Swedish hospital s, there seems to be substantial potential remaining for further reduc tion of perfunctory use of preoperative screening.