Efficacy and financial benefit of an anesthesiologist-directed university preadmission evaluation center

Abstract

Study objective: To study the effectiveness of an anesthesiologist-directed preadmission evaluation center (PEC) in our institution.

Design: I: Preoperative test costs were measured on two sets of patients undergoing same-day surgery. II: Rate of cancellation was measured on all patients undergoing same-day surgery in a subsequent one-year time period.

Setting: The PEC, short procedure unit, and same-day admission unit of a university hospital.

Patients: I: 3,062 male and female patients undergoing same-day surgery between January 1, 1992, and August 31, 1992. II: 9,454 male and female patients undergoing same-day surgery between July 1, 1993, and June 30, 1994.

Interventions: Age, ASA physical status, type of surgery performed, and tests ordered were recorded in two groups of same-day surgical patients. Group S had testing primarily ordered by surgeons, augmented by the anesthesiologists in the PEC. Group A had testing primarily ordered by the anesthesiologists in the PEC, but surgeons could still order tests they felt necessary. On the day of surgery, the attending anesthesiologist recorded any additional testing that was required or would have altered intraoperative management. In a follow-up study, cancellations of same-day surgical patients were recorded for a one-year period.

Measurements and main results: I: With the exception of complete blood counts with differentials, significantly fewer tests were ordered in Group A than Group S. These changes produced an average cost savings of $20.89 per patient. There were no recorded cancellations or apparent alterations in intraoperative management attributable to inadequate testing. II: Of the 9,454 same-day procedures from 7/1/93 to 6/31/94, 66 were cancelled on the day of the procedure. None of the patients seen in the PEC were cancelled due to causes possibly preventable by a PEC, unlike the cases of 4 patients who had not been evaluated in teh PEC and were cancelled.

Conclusion: A PEC, in which the anesthesiologist primarily orders preoperative tests and approves patients' readiness for surgery, is both an efficient and cost-effective system.