Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

Santos, Mônica Loureiro Maués; Iglesias, Antonio

doi:10.1590/0100-69912017001015

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…workup when ordered selectively [14]. Several other studies and recommendations concur with St Clair et al's finding that a CBC is often unnecessarily ordered [13,15,19,24,30].…”

Section: Complete Blood Countsupporting

confidence: 59%

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Shields

Kho

2019

Journal of Minimally Invasive Gynecology

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Preoperative evaluation for elective benign gynecologic procedures is a necessary step in reducing perioperative complications. Although a thorough history and physical examination are the foundation of this assessment, much evidence exists that physicians rely on unnecessary laboratory and diagnostic testing. Our goal was to perform a systematic review of the available literature regarding preoperative evaluation to better inform preoperative test selection and to identify deficiencies in the current literature. There is very limited data specific to preoperative testing for patients undergoing gynecologic surgeries. Abnormal test results are common when routine, unselected testing is applied. Using a protocol to guide preoperative testing improves patient care by eliminating unnecessary tests without compromising the efficacy of predicting adverse perioperative events or case cancellation and modifications.

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“…workup when ordered selectively [14]. Several other studies and recommendations concur with St Clair et al's finding that a CBC is often unnecessarily ordered [13,15,19,24,30].…”

Section: Complete Blood Countsupporting

confidence: 59%

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Shields

Kho

2019

Journal of Minimally Invasive Gynecology

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“…In another study, researchers assigned patients to either a routine group or a protocol group for preoperative testing. Licensed practitioners were mandated to order specific preoperative tests for patients assigned to the protocol group, and the results showed a 57.3% reduction in testing for this group 17 . In our QI project, the ordering practitioners were not forced to adhere to the laboratory testing protocol for their patients.…”

Section: Discussionmentioning

confidence: 99%

“…In Brazil, results of a randomized masked clinical trial found no significant difference in perioperative morbidity and mortality after the implementation of a preoperative examination protocol. 17 In Barbados, researchers conducted a prospective study to determine the association between the effect of preoperative testing guidelines on costs and anesthesia practices. 18 Although costs (ie, chest radiography, complete blood count) decreased during the study, there was no significant decrease in the mean number of preoperative tests before and after the guideline implementation, and abnormal test results did not affect the anesthetic plan.…”

Section: Statement Of Goals and Objectivesmentioning

confidence: 99%

“…The project leader examined quantitative studies that sought to assess the effects of limiting preoperative testing on the overall morbidity and mortality of the patient or addressed costs. In Brazil, results of a randomized masked clinical trial found no significant difference in perioperative morbidity and mortality after the implementation of a preoperative examination protocol 17 . In Barbados, researchers conducted a prospective study to determine the association between the effect of preoperative testing guidelines on costs and anesthesia practices 18 .…”

Section: Literature Reviewmentioning

confidence: 99%

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Improving Compliance With Evidence‐Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes

Hawkins,

Moynihan,

Glassman

et al. 2024

AORN Journal

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A team comprising nursing, medical staff, and administrative leaders at an urban academic orthopedic hospital in the northeastern United States sought to revise a preoperative laboratory testing protocol based on evidence and practice guidelines. The goal was to decrease unnecessary tests by 20% without negatively affecting patient outcomes. After adding the revised protocol to the electronic health record, audits revealed that the target goal was not met and additional strategies were implemented, including educational webinars for surgeon office personnel who ordered tests, additional webinars for advanced practice professionals, and the creation of scorecards to track surgeons’ progress. Overall, a downward trend in the ordering of unnecessary laboratory tests for patients without identified risks was observed, but a 20% reduction was not achieved. Surgical complications during the project were not associated with laboratory tests. Clinicians continue to use the revised preoperative laboratory testing protocol at the facility.

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“…Although each is unique, all emphasize a tailored preoperative care approach by basing the need for testing or other interventions on both patient‐ and surgery‐specific factors . Guideline adherence can reduce extraneous testing and cost without impacting perioperative morbidity and mortality (M&M) …”

Section: Overview Of the Preoperative Patient Evaluationmentioning

confidence: 99%

The evidence‐based preoperative assessment for the otolaryngologist

et al. 2019

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There is a narrow window of opportunity between surgical scheduling and the operative date to optimize patients for an elective surgical procedure. Traditionally, preoperative care has involved extended routine testing batteries with intermittent referrals for medical clearance. These traditions are costly, inefficient, and yield no clear reduction in perioperative morbidity and mortality. Evidence, which has evolved over the past decade, suggests that optimal preoperative care requires a patient-centric, personalized, and often multidisciplinary approach. We present an up-to-date overview of this literature with a focus on the otolaryngologic surgical population. An algorithmic approach to preoperative patient assessment is also proposed in hopes of both optimizing patient outcome and streamlining routine clinical workflow.

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Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

Cited by 4 publications

References 19 publications

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Improving Compliance With Evidence‐Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes

The evidence‐based preoperative assessment for the otolaryngologist

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