TY - JOUR T1 - Quality improvement in preoperative assessment by implementation of an electronic decision support tool. JF - J Am Med Inform Assoc Y1 - 2013 A1 - Flamm, Maria A1 - Fritsch, Gerhard A1 - Hysek, Martin A1 - Klausner, Sabine A1 - Entacher, Karl A1 - Panisch, Sigrid A1 - Soennichsen, Andreas C KW - Adult KW - Aged KW - Austria KW - Decision Support Systems, Clinical KW - Diagnostic Tests, Routine KW - Elective Surgical Procedures KW - Female KW - Guideline Adherence KW - Humans KW - Male KW - Middle Aged KW - Practice Guidelines as Topic KW - Preoperative Care KW - Quality Improvement AB -

OBJECTIVES: To evaluate the impact of the electronic decision support (eDS) tool 'PReOPerative evaluation' (PROP) on guideline adherence in preoperative assessment in statutory health care in Salzburg, Austria.

MATERIALS AND METHODS: The evaluation was designed as a non-randomized controlled trial with a historical control group (CG). In 2007, we consecutively recruited 1363 patients admitted for elective surgery, and evaluated the preoperative assessment. In 2008, PROP was implemented and available online. In 2009 we recruited 1148 patients preoperatively assessed using PROP (294 outpatients, 854 hospital sector). Our analysis includes full blood count, liver function tests, coagulation parameters, electrolytes, ECG, and chest x-ray.

RESULTS: The number of tests/patient without indication was 3.39 in the CG vs 0.60 in the intervention group (IG) (p<0.001). 97.8% (CG) vs 31.5% (IG) received at least one unnecessary test. However, we also observed an increase in recommended tests not performed/patient (0.05±0.27 (CG) vs 0.55±1.00 (IG), p<0.001). 4.2% (CG) vs 30.1% (IG) missed at least one necessary test. The guideline adherence (correctly tested/not tested) improved distinctively for all tests (1.6% (CG) vs 49.3% (IG), p<0.001).

DISCUSSION: PROP reduced the number of unnecessary tests/patient by 2.79 which implied a reduction of patients' burden, and a relevant cut in unnecessary costs. However, the advantage in specificity caused an increase in the number of patients incorrectly not tested. Further research is required regarding the impact of PROP on perioperative outcomes.

VL - 20 IS - e1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/23599223?dopt=Abstract ER -