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. 1998 Mar;7(1):5–11. doi: 10.1136/qshc.7.1.5

Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital

S Capdenat Saint-Martin, P Michel, J M Raymond, H Iskandar, C Chevalier, M N Petitpierre, L Daubech, M Amouretti, P Maurette
PMCID: PMC2483578  PMID: 10178152

Abstract

OBJECTIVE: To describe the effect of local adaptation of national guidelines 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 one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. SETTING: Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. SUBJECTS: 42 anaesthetists, 60 surgeons, and their teams. MAIN OUTCOME MEASURES: Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings. RESULTS: Of 536 patients at low risk from anaesthetics 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 within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied 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 changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. CONCLUSIONS: A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change.

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Selected References

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  1. Amouretti M., Beraud C., Saint-Martin E. Medical audit in France: from ideal to reality. BMJ. 1992 Feb 15;304(6824):428–430. doi: 10.1136/bmj.304.6824.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blery C., Charpak Y., Szatan M., Darne B., Fourgeaux B., Chastang C., Gaudy J. H. Evaluation of a protocol for selective ordering of preoperative tests. Lancet. 1986 Jan 18;1(8473):139–141. doi: 10.1016/s0140-6736(86)92271-3. [DOI] [PubMed] [Google Scholar]
  3. Blery C., Chastang C., Gaudy J. H. Critical assessment of routine preoperative investigations. Eff Health Care. 1983 Aug;1(2):111–114. [PubMed] [Google Scholar]
  4. Charpak Y., Nicoulet I., Bléry C. Pratiques et attitudes actuelles des médecins anesthésistes en matière de prescription d'examens paracliniques préopératoires. Ann Fr Anesth Reanim. 1992;11(5):576–583. doi: 10.1016/s0750-7658(05)80763-4. [DOI] [PubMed] [Google Scholar]
  5. Eccles M., Clapp Z., Grimshaw J., Adams P. C., Higgins B., Purves I., Russell I. North of England evidence based guidelines development project: methods of guideline development. BMJ. 1996 Mar 23;312(7033):760–762. doi: 10.1136/bmj.312.7033.760. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ellis B. W., Sensky T. A clinician's guide to setting up audit. BMJ. 1991 Mar 23;302(6778):704–707. doi: 10.1136/bmj.302.6778.704. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fowkes F. G., Davies E. R., Evans K. T., Green G., Hartley G., Hugh A. E., Nolan D. J., Power A. L., Roberts C. J., Roylance J. Multicentre trial of four strategies to reduce use of a radiological test. Lancet. 1986 Feb 15;1(8477):367–370. doi: 10.1016/s0140-6736(86)92327-5. [DOI] [PubMed] [Google Scholar]
  8. Giraud A. Medical audit in France: historical perspective. BMJ. 1992 Feb 15;304(6824):426–428. doi: 10.1136/bmj.304.6824.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Goldberger A. L., O'Konski M. Utility of the routine electrocardiogram before surgery and on general hospital admission. Critical review and new guidelines. Ann Intern Med. 1986 Oct;105(4):552–557. doi: 10.7326/0003-4819-105-4-552. [DOI] [PubMed] [Google Scholar]
  10. Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
  11. Kaplan E. B., Sheiner L. B., Boeckmann A. J., Roizen M. F., Beal S. L., Cohen S. N., Nicoll C. D. The usefulness of preoperative laboratory screening. JAMA. 1985 Jun 28;253(24):3576–3581. [PubMed] [Google Scholar]
  12. Lomas J., Enkin M., Anderson G. M., Hannah W. J., Vayda E., Singer J. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. JAMA. 1991 May 1;265(17):2202–2207. [PubMed] [Google Scholar]
  13. McCleane G. J. Urea and electrolyte measurement in pre-operative surgical patients. Anaesthesia. 1988 May;43(5):413–415. doi: 10.1111/j.1365-2044.1988.tb09029.x. [DOI] [PubMed] [Google Scholar]
  14. McKee C. M., Lauglo M., Lessof L. Medical audit: a review. J R Soc Med. 1989 Aug;82(8):474–478. doi: 10.1177/014107688908200810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Michel P., Capdenat E., Raymond J. M., Maurette P., Daubech L., Salamon R., Amouretti M. Regional experience of evaluation of professional practice and quality assurance implementation in Aquitaine. Int J Qual Health Care. 1997 Jun;9(3):221–223. doi: 10.1093/intqhc/9.3.221. [DOI] [PubMed] [Google Scholar]
  16. Mozes B., Lubin D., Modan B., Ben-Bassat I., Gitel S. N., Halkin H. Evaluation of an intervention aimed at reducing inappropriate use of preoperative blood coagulation tests. Arch Intern Med. 1989 Aug;149(8):1836–1838. [PubMed] [Google Scholar]
  17. Mugford M., Banfield P., O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. doi: 10.1136/bmj.303.6799.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Roberts C. J., Fowkes F. G., Ennis W. P., Mitchell M. Possible impact of audit on chest X-ray requests from surgical wards. Lancet. 1983 Aug 20;2(8347):446–448. doi: 10.1016/s0140-6736(83)90403-8. [DOI] [PubMed] [Google Scholar]
  19. Rohrer M. J., Michelotti M. C., Nahrwold D. L. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg. 1988 Nov;208(5):554–557. doi: 10.1097/00000658-198811000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Russell I. T., Wilson B. J. Audit: the third clinical science? Qual Health Care. 1992 Mar;1(1):51–55. doi: 10.1136/qshc.1.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Stocking B. Promoting change in clinical care. Qual Health Care. 1992 Mar;1(1):56–60. doi: 10.1136/qshc.1.1.56. [DOI] [PMC free article] [PubMed] [Google Scholar]

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