• R Bernard, D Benhamou, and H Beloeil.
• Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
• Ann Fr Anesth Reanim. 2010 Dec 1; 29 (12): 868-73.

Objectiveto compare the number and the cost of preoperative tests ordered before scheduled surgery before and after implementation of local guidelines.Study Designobservational retrospective survey.PatientsAll patients scheduled in seven surgical specialties.Methodsall preoperative tests ordered during a 1-week period (2008) were noted. Local guidelines based on published guidelines and validated by anesthesiologists of the hospital were then implemented. A second audit was performed 1 year after (2009).ResultsEighty-five and 79 patients' files were analyzed in 2008 and 2009, respectively. On average, half (46% in 2008 and 58% in 2009) of prescriptions did not follow the guidelines, with anaesthesiologists prescribing more than their own recommendations. Overall conformity to the local guidelines did not improve between 2008 and 2009. However, EKG (79% vs. 95%, p<0.05) and serum electrolytes (72% vs. 99%, p<0.05) ordered were significantly in better agreement with the guidelines. Costs associated with inadequate orders were divided by 2.4 in 2009.Conclusionsexisting practice is overall poor. Non-compliance of preoperative testing to guidelines is a significant cause of uncontrolled cost. Change in compliance is a slow process.2010 Elsevier Masson SAS. All rights reserved.

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