Limited Preoperative Testing and Its Effect on Surgical Outcomes: Implementing an Evidence Based Testing Protocol

Abstract

The focus of preoperative testing has evolved from screening all preoperative patients to identify surgical risk, to targeting specific evaluations and treatments in patients only when clinically warranted. At an academic orthopedic hospital in an urban setting in the northeastern United States, preoperative testing is performed routinely prior to elective orthopedic surgeries. Even though these tests are considered routine practice, evidence does not support standard testing for all patients. Excess preoperative testing is a problem of healthcare waste at this facility, and limiting it is a necessary step towards both evidence-based practice and preserving hospital resources. To close the gap between excess and necessary testing for preoperative patients, a testing protocol was implemented to limit preoperative testing. The Ottawa Model of Research Use (OMRU) framework was used to engage stakeholders and promote the protocol. Providers attended webinars to reiterate the scientific evidence behind the protocol. Assessments of compliance with the testing protocol were made via chart review within the electronic medical record throughout 4 phases of the project. A scorecard of surgeon compliance was also created for department transparency and to assess for improvement opportunities. There was a downtrend of excess testing within the Preadmission Testing Department. However, it did not meet the original goal of 20% reduction in excess testing. Throughout the project timeline, the surgical complication rate was flat between 1.3% to 5.6%. No surgical complications could be directly attributed to lack of preoperative testing.