Effective strategy to guide pathology test ordering in surgical patients

Abstract

Provided that certain preliminary guidelines are followed, these protocols can reduce pathology test ordering in any pre-admission Service.

What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature

“…Two hundred and eighty-two references were identified as relevant from the title and abstract sifting using the abstract selection criteria. Of the 282 full manuscripts that were obtained for further assessment, eight papers [36][37][38][39][40][41][42][43] (one full economic evaluation 36 and seven partial economic evaluations [37][38][39][40][41][42][43] ) were identified for data extraction.…”

“…Only one full economic evaluation was identified. 36 Although we additionally reported seven further partial economic evaluations [37][38][39][40][41][42][43] with a view to extracting data that might be used in an economic model, these too provided few data that could be utilised.…”

“…Three studies presented findings of guideline or protocol implementation. 37,42,43 These studies focused on deriving total costs and costs per patient to show the benefits of carrying out a reduced number of routine testing. They did not provide enough detailed cost data to inform the building of an economic model.…”

“…MacPherson et al 43 assessed whether or not the introduction of a protocol-based test ordering system (or a guideline) would reduce ordering of inappropriate pathology tests in surgical patients attending a pre-admission clinic (PAC) in a hospital based in Australia. The guideline provided information in two parts: the first contained information about tests to be ordered on the basis of the proposed surgical procedure and the second provided a list of test to be ordered according to a pre-existing medical condition.…”

Routine preoperative blood testing in pediatric neurosurgery

“…13,22 The same preoperative protocol is applied to healthy children undergoing elec tive surgery, and its effectiveness has been the focus of many studies. 6,10 Pediatric neurosurgical procedures are complex and require comprehensive preoperative evaluation for deter mining the fitness of a child for anesthesia and surgery. 20 There is no published evidence regarding the usefulness of preoperative blood testing before pediatric neurosur gery and whether the series of screening tests does in fact affect the management plan and outcome of elective sur gery.…”