DESCRIPTION OF LOCAL ADAPTATION OF NATIONAL GUIDELINES AND OF ACTIVE FEEDBACK FOR RATIONALIZING PREOPERATIVE SCREENING IN PATIENTS AT LOW-RISK FROM ANESTHETICS IN A FRENCH UNIVERSITY HOSPITAL

Objective-To describe the effect of local adaptation of national guide lines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics. Design-Assessment of preoperative tests ordered over on e month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. Setting-Motivate d anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. Subjects-42 anaesthetists, 60 surgeons, and t heir teams. Main outcome measures-Number and type of preoperative test s ordered in June 1993 and 1994, and the estimated savings. Results-Of 536 patients at low risk from aneasthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication w ithin teams. Changes implemented included scheduling of anaesthetic co nsultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studie d in 1994 after the intervention only 48% had one or more preoperative tests ordered (p<0.05). Estimated mean (SD) saving for one year if ch anges were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. Conclusions-A sharp decrease in tests order ed in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedba ck, and organisational change.