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  1. Continuous improvement, quality control, and cost containment in clinical laboratory testing : effects of establishing and implementing guidelines for preoperative tests.

    Article - En anglais

    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.

    Mots-clés Pascal : Biologie clinique, Anatomopathologie, Assurance qualité, Coût, Prescription, Examen laboratoire, Préopératoire, Recommandation, Analyse coût efficacité, Economie santé

    Mots-clés Pascal anglais : Clinical biology, Pathology, Quality assurance, Costs, Prescription, Laboratory investigations, Preoperative, Recommendation, Cost efficiency analysis, Health economy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0540867

    Code Inist : 002B24O14. Création : 01/03/1996.