Saving Time and Money: The Impact of Streamlining Preoperative Testing Guidelines

INTRODUCTION: Cost reduction is a major concern for healthcare systems. Routine preoperative testing can increase healthcare costs and contribute to increased workload for clinical staff without improving patient outcomes. Through a multidisciplinary collaboration with urogynecology, perioperative hospital nursing staff leadership, and anesthesiology, urogynecology-specific preoperative testing guidelines (Table 1) were developed and implemented. A perioperative communication workflow (Figure 1) was designed to create efficiency in the complex surgical scheduling process. OBJECTIVE: To evaluate cost savings and clinical workload time savings after the implementation of evidence-based, urogynecology-specific preoperative testing guidelines and a perioperative communication workflow. METHODS: We compiled a list of urogynecology surgical cases prior to (5/1/24–5/31/24) and after (7/1/24–8/31/24) implementation of the urogynecology-specific preoperative guidelines. Data was collected regarding number of surgical cases, expected preoperative tests ordered (without guidelines), and actual preoperative tests ordered (with the new guidelines). Preoperative testing included complete blood count (CBC), basic metabolic panel (BMP), hemoglobin A1C (HgbA1c), electrocardiogram (EKG), and urinalysis (UA). Total cost of unindicated testing prior to guideline implementation and projected cost based on pre-implementation data were calculated. The number of nursing phone calls per patient related to preoperative testing was prospectively tracked by the nurse navigator. RESULTS: Before implementation, 51 unindicated tests were ordered for 24/38 surgical patients (63.2%), costing a total of $10,463 (Table 2). After implementation, no unindicated tests were ordered for the 64 surgical patients. Based on pre-implementation test ordering, a projected total of 86 unindicated tests for projected number of 40 patients would have been expected to total approximately $17,621. Before implementation, preoperative nurses called patients a median of 2 times to discuss preoperative testing, whereas, after implementation, no phone calls were required. CONCLUSIONS: Developing and implementing urogynecology-specific preoperative testing guidelines and a perioperative communication workflow improved time and cost efficiency for ordering and scheduling preoperative testing. The cost savings of preventing unnecessary preoperative testing within a Urogynecology practice aids in delivering value-based care.