• Judith Nicholls, Pamela S Gaskin, Justin Ward, and Yasodananda K Areti.
• Department of Anaesthesia, Queen Elizabeth Hospital, Martindales Road, St Michael, Barbados. Electronic address: judith.l.nicholls@gmail.com.
• J Clin Anesth. 2016 Dec 1; 35: 176-189.

Study ObjectiveWe endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices.DesignA prospective study.SettingQueen Elizabeth Hospital, Barbados.PatientsParticipants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required.InterventionIntroduction of formal guidelines for preoperative investigations.MeasurementsThe patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments.Main ResultsFor younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications.ConclusionOur findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.Copyright © 2016 Elsevier Inc. All rights reserved.

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