Save $250,000 a year with testing guidelines

Just to make sure that nothing is missed, your surgeons order every preoperative test known to modern man. And then to make sure nothing was missed, your anesthesiologists order every test again.

Sound familiar? St. Luke’s Hospital, the New Bedford (MA) site of Southcoast Hospitals Group, was experiencing this problem but now is using preoperative anesthesia testing guidelines to save $250,000 per year. The guidelines explain the types of lab tests, EKGs, and chest X-rays performed for specific American Society of Anesthesiologists (ASA) classifications of patients. (See guidelines inserted in this issue.)

"It took a lot of education, working with surgeons over the course of a year," says Cheryl Leporacci, manager of anesthesia services.

Most surgeons now send their patients to preadmission testing with the records marked "pre-op work per anesthesia," so anesthesia picks the preoperative tests by using the guidelines.

Tests are done 7-10 days ahead

Interestingly, with many same-day surgery programs moving toward preoperative testing on the day of surgery, St. Luke’s Hospital is heading in the opposite direction. But it all depends on your patient population, says Lyn Ames, MS, RN, CNOR, CNAA, director of perioperative services. Ames spoke recently at the Same-Day Surgery Conference, sponsored by Same-Day Surgery newsletter, held in Washington, DC.

The patient population at St. Luke’s is half Portuguese immigrants, and half of them are older than age 55.

In areas with younger populations that are well-educated, patients tend to have primary care physicians and have routine health checks. For that reason, there are few surprises on the day of surgery.

"But if you happen to live in New Bedford, people don’t have primary care physicians, they don’t understand the language, they don’t understand compliance or have a lot of money, and their nutritional status isn’t great," Ames says. "On the morning of surgery, if you relied on that to be the time to get them ready for ACL or a diagnostic lap case or lap choly, you’d be in big trouble." You might find out the patient was a diabetic or had tuberculosis and have to cancel surgery, she warns.

St. Luke’s has preadmission testing done within seven to 10 days of surgery. "If patients need a medical clearance or cardiac workup, we have enough time to get it done, with that time frame," Leporacci says.

Protocols were put in place by a task force that worked with radiology, medical records, and the EKG technician to obtain their buy-in.

"One of the early things we did was that frequently we were delayed in the morning because we didn’t have a chest X-ray read, and the radiologist wouldn’t come in until 7:30 a.m., so we had to change the way we ordered them and when they were ordered," Leporacci says. "Now, if they’re ordered, they’re done the day of preadmission testing."

Usually only ASA Class 1 or Class 2 patients have preoperative tests on the day of surgery.

The hospital also is testing telephone preoperative screening.