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International Journal for Quality in Health Care Advance Access published online on April 14, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi039
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International Journal for Quality in Health Care © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted March 6, 2005

Article

Guidelines for preoperative assessment: impact on clinical practice and costs

Alberto Ferrando 1*, Cristiana Ivaldi 1, Alessandro Buttiglieri 2, Eva Pagano 1, Chiara Bonetto 3, Roberto Arione 4, Luca Scaglione 1, Elena Gelormino 1, Franco Merletti 1, and Giovannino Ciccone 1

1 ASO San Giovanni Battista, Università Di Torino And Cpo Piemonte, Unit of Cancer Epidemiology, Torino, Italy
2 ASO San Giovanni Battista, 7th Unit of Anaesthesiology and Reanimation, Torino, Italy
3 ASO San Giovanni Battista, 1st School of Anaesthesiology and Reanimation, Torino, Italy
4 ASO San Giovanni Battista, Hospital Director, Torino, Italy

* To whom correspondence should be addressed.
Alberto Ferrando, E-mail: aferrando{at}molinette.piemonte.it


  Abstract

Objective. To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented.

Design. We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization.

Main measures. Mean number of tests prescribed, preoperative assessment cost per patient.

Results. The application of preoperative guidelines would decrease the mean number of tests prescribed from 20 laboratory and 1.9 instrumental to, respectively, 3 and 1.4 per patient. Tests deemed inappropriate by guidelines did not add any relevant clinical information to our study. Economic analysis estimates a reduction of 63% in cost per patient for preoperative tests by introducing guideline criteria (from {euro}69 to {euro}26). As regards the cost per patient for preoperative evaluation and hospital stay ({euro}115 considering only variable costs, {euro}580 including all costs), the application of the guidelines would reduce costs by 41-52% according to different cost evaluation approaches for hospital stay.

Conclusion. Preoperative guidelines fully introduced in practice could notably increase efficiency without affecting the quality of care.

Keywords: anaesthesiology, ASA classification, cost and cost analysis, hospital economics, practice guidelines, preoperative tests.
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