Objective

- To develop guidelines for laboratory tests ordered before admission for elective surgery.

Design

- A seven-step continuous quality improvement process.

Setting

- The Departments of Laboratory Medicine, Surgery, and Anesthesia of the University of Massachusetts Medical Center, a 384-bed, teaching, tertiary-care facility.

Participants

- Core group of the Department of Laboratory Medicine and the Laboratory Medical Advisory Committee.

Intervention

- Guidelines were developed for laboratory tests ordered before elective surgery.

They were divided into four major groups as well as by age and gender.

Main Outcome Measure

- Charts chosen at random by the medical records department for the period prior to implementation of guidelines were reviewed and compared with records 1 and 2 years later.

Results

- Reductions of 50% and 60% in the first and second years, respectively, in the overall number of tests ordered per patient were demonstrated.

An improvement in the appropriateness of tests was also documented : 81% in the first year and 86% in the second year, compared with 65% appropriateness prior to implementation of guidelines.

Conclusions

- We have described an approach that involves a sustained educational effort and collaboration of nurses and physicians and have presented specific guidelines for preoperative testing.

A major decrease in the number of tests ordered, an increase in their appropriateness, and marked fiscal savings were documented.