Applying Existing Guidelines for Pre-op Testing Leads to Significant Savings

Author: Ajai Raj

Anesthesiology News

Analyzing the impact of implementing patient-centered protocols for preoperative anesthesia testing at their institution, a team at Rutgers New Jersey Medical School discovered an unexpected dividend: an annual cost reduction of more than 50%, which was nearly $200,000.

Presenting the study at the 2018 annual meeting of the Society for Ambulatory Anesthesia (abstract 1826), the researchers described how following joint guidelines for individualized patient testing from the United Kingdom’s National Institute for Health and Care Excellence and the American Society of Anesthesiologists resulted in a savings of $199,850 over 11 months (August 2016-June 2017) for essentially a 54.4% savings in hospital expenditures.

Average monthly costs decreased from $33,333 to $15,183, with the average cost per patient falling from $144.29 to $67.40, as the result of applying current guidelines to everyday practice in the preadmission testing unit, and thereby reducing unnecessary expenses, the authors noted.

Neither the study nor the implementation of the guidelines themselves was performed with cost savings in mind, said Somdatta Gupta, MD, a resident in anesthesiology at Rutgers and first author of the study.

“The main initial incentive was to prevent patients from undergoing unnecessary testing,” Dr. Gupta said. “The previous system was not well-organized. Many of the tests ordered by different surgical specialties were actually not indicated for that specific patient undergoing that specific surgery. This led to unnecessary costs and was a drain on hospital resources, to say nothing of the patients’ time, so we decided to incorporate a targeted, patient-centered approach in order to streamline the whole preoperative anesthesia testing process.” The approach included conveying to all surgical specialties in the hospital that only eligible personnel from the preadmission testing division of the anesthesiology department could order preoperative tests.

“Since a lot of preoperative tests are ordered by the surgical specialties, there is always a possibility of conflict between the [preadmission testing] clinic and the surgical specialties,” she said. “At that point, the question becomes what do we convey to the surgery team? We conveyed to them that we will follow current evidence-based anesthesia guidelines, even if that means waiving tests they’ve ordered.

“And yes, at the beginning, as with all new rules, there was a certain amount of friction and back-and-forth between us and the surgical specialties, but soon the dust settled when we realized we’re all on the same page and we are doing what’s best for the patient,” she said.

Emphasizing that cost savings is only part of the benefit from taking a streamlined, guidelines-based approach to preoperative testing, Dr. Gupta said the next step in the team’s research is to quantify and report the effect their new guidelines have had on patient satisfaction. “We see that surgery outcomes remain unchanged, and the patients express more satisfaction to us as physicians when we interview them, so we’re interested to see exactly how much that’s changed.”

Dr. Gupta said that based on questions and discussion she has encountered when these data are presented at national conferences, preadmission testing advisories often go unapplied. “I realized that there are many institutions that want to apply these guidelines in their practice but have not done so because they’re not sure about the benefits, since so few institutions across the country actually followed them.

“We didn’t have a clear idea of what the cost savings would be when we implemented the guidelines,” she pointed out. “We just wanted to make it more efficient in terms of time, resources and patient experience.”