PREPROCEDURE TESTING OF ASYMPTOMATIC PATIENTS

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S36 INTRODUCTION: Several studies have shown the inefficiency of ordering preprocedure laboratory tests (PLT's) on patients who have no evidence of disease based upon their history and physical examination (H & P) [1,2]. Despite efforts to educate our medical staff, this practice persisted. Based on preprocedure laboratory testing guidelines which are derived from the H & P, what portion of tests ordered in our teaching hospital were inappropriately requested and what was the outcome? METHODS: After obtaining approval from our Institutional Review Board (consent document not required), one hundred and one consecutive patients 18 years or older presenting for a procedure at our University Hospital were studied. The PLT's ordered, the result(s), the disposition of the abnormal result(s), and patient outcome data were recorded. Prospectively defined, published criteria [3] were used to determine the appropriateness of each PLT ordered. The reviewer determining test appropriateness was blinded to the test results and the outcome data. The H & P from both the medical service group performing the procedure and the anesthesiology team (if applicable) were used. RESULTS: Forty-nine patients were male; the mean age was 46.1 +/- 14.0 years old. Of the 66 patients who required anesthesia services, 8 (12.1%), 38 (57.6%), or 20 (30.3%) were ASA 1, 2, or 3, respectively. Of the sample, the number of patients for whom each test was ordered is shown on Table 1, Column A. Of the tests ordered, the number of inappropriate tests is shown in Column B. Of the inappropriate tests, the number of abnormal test results is shown in Column C.Table 1Of 184 tests ordered, 75 (40.8%) were deemed inappropriate. Of the inappropriate tests ordered, no action was taken upon any of the abnormal results. No patient who underwent inappropriate testing suffered an adverse outcome that may have been detected by the test. For example, of the thirty-six (35.6%) patients who had coagulation studies ordered, 33 (91.7%) were inappropriate. The inappropriately tested patients suffered no adverse outcome related to bleeding. Of the inappropriate tests, 4 (12.1%) were abnormal (partial thromboplastin times from 33.2 - 39.0 seconds and a prothrombin time of 15.0 seconds). DISCUSSION: In our hospital, many PLT's are inappropriately requested, based upon H & P criteria. In our sample, no abnormal result generated by inappropriate testing was acted upon, and no adverse outcome resulted from an abnormality potentially missed by testing an asymptomatic patient.

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