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Clearer NICE Guidelines for Pre-Operative Blood Investigations

This study examines whether clearer NICE guidelines on pre-operative blood investigations can lead to a reduction in unnecessary testing and reduce costs in elective day-case patients.

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Clearer NICE Guidelines for Pre-Operative Blood Investigations

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  1. Would clearer NICE guidelines on pre-operative blood investigations lead to a reduction in unnecessary testing and reduce cost in elective day-case patients? J.T Grainger, L Kocierz, C Kearsey, R.H.R Soulsby Presented by Dr L Kocierz BADS 2010, Portsmouth New Cross Hospital, Wolverhampton Department of Colorectal Surgery

  2. Introduction • NICE Guidelines for preoperative investigations were designed for: • Elective Surgery • Varying ASA grades • Varying grades of surgery • Preoperative investigations aim to provide additional information • Reduce possible harm • Change clinical management

  3. NICE Guidelines • NICE suggests clinical value of testing asymptomatic healthy patients is uncertain • False positive may lead to unnecessary treatments and investigations • Do abnormal results actually lead to a change in clinical practice? • Anaesthetic • Surgical • NICE suggests if normal blood results in 6/12 then they do not need repeating

  4. Aim • Do pre-operative blood investigations for general surgical day case patients comply with NICE Guidelines at New Cross Hospital? • Does a simpler version of the NICE Guidelines reduce unnecessary testing?

  5. Method • Initial audit: 33 patients over 5 week period • Then introduced new version of guidelines, educated nurses over 2 week period • Post implementation: 35 patients over 3 week period • Standard proforma • Main data collected: • Demographics • Co-morbidity • Medications • FH Bleeding disorders • Grade of surgery • ASA Grade

  6. Methods • NICE Guidelines were used to determine which blood tests should have been performed • Compared against the actual tests performed • Whether results altered management • Whether blood test in last 6 months

  7. NICE Guidelines

  8. ‘User Friendly’ NICE Guidelines

  9. Results

  10. % %

  11. %

  12. Results • Normal blood results within 6/12 which were repeated: • 100% in Pre Implementation Group • 40% in Post Implementation Group • Overall compliance with NICE Guidelines: • 16% Pre Implementation • 58% Post Implementation • There was no evidence of change in clinical management for either group when abnormal blood results were detected

  13. Discussion • We are not complying with NICE Guidelines • Lack of awareness • Patients still tested even if normal results in last 6 months • Initial audit showed £1600 per session per year wasted • No evidence abnormal results changed anaesthetic or surgical practice

  14. Recommendation • Reassess NICE guidelines locally to institute clearer guidelines for pre-operative assessors • Increase awareness of guidelines • Re-audit to assess compliance

  15. Conclusion • Complicated NICE guidelines lead to over investigation of day case patients • Unnecessary tests for patient • Unnecessary cost

  16. Thank You Any Questions?

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