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Forschungsdatenbank PMU-SQQUID

Quality improvement in preoperative assessment by implementation of an electronic decision support tool.
Flamm, M; Fritsch, G; Hysek, M; Klausner, S; Entacher, K; Panisch, S; Soennichsen, AC
J Am Med Inform Assoc. 2013; 20(e1):e91-e96
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Flamm Maria
Fritsch Gerhard
Panisch Sigrid

Abstract

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.
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.
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).
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.


Useful keywords (using NLM MeSH Indexing)

Adult

Aged

Austria

Decision Support Systems, Clinical*

Diagnostic Tests, Routine/economics

Diagnostic Tests, Routine/standards

Diagnostic Tests, Routine/utilization*

Female

Guideline Adherence

Humans

Male

Middle Aged

Practice Guidelines as Topic

Preoperative Care/standards*

Quality Improvement

Surgical Procedures, Elective/standards*