Patients of the Regina Pre-Admission Clinic preparing for elective hip and knee surgery are experiencing fewer unnecessary tests and, as a result, requiring fewer physician consultations because of a new screening process.
“Our patients have benefited greatly," said Emilie Jewett-Curley, manager of Regina's Pre-Admission Clinic. “In reducing the number of required consults and tests, we have also reduced the amount of travel time to and from the Pre-Admission Clinic or lab. With this group of patients, we now have found that often their needs can be addressed with a phone consultation."
The screening process, or algorithm, was launched two years ago by Dr. Theo le Roux and the team at the Pre-Admission Clinic.
“Dr. le Roux, an anesthesiologist who worked in the clinic at the time, saw an opportunity to make some positive changes," said Tom Stewart, manager of special projects in Surgical Care Services. “He would, on occasion, see a patient for a pre-op consult who was healthy and the consult ordered wasn't required. This led to the creation of the algorithm, making sure the right patients get the right tests, at the right time, based on their health history."
An evaluation of 90 patient charts in 2016-17 showed the algorithm helped identify 149 blood tests which did not need to be ordered. Over one year, it's projected the algorithm would help pinpoint and prevent 3,000 unnecessary tests and 551 physician consultations.
The total projected savings for one year would be approximately $210, 000, not including indirect savings.
Based on the success of this project, a provincial group is working on an algorithm for all elective surgeries.
“It's currently being developed and has great promise," said Stewart.
How the algorithm works
The surgeon completes and submits a booking form which details the tests and consultations necessary for that particular patient based on their unique health history.
During their initial visit to the surgeon, patients complete a questionnaire about their health history. The questionnaire helps screen patients for underlying issues that could prevent them from having a safe operation. The document is received by the registered nurse in the Pre-admission Clinic who ensures the most appropriate tests and consultations have been requested.
The nurses at the clinic say the new process is a definite improvement. By having a robust patient history during the screening process, fewer calls are made to obtain necessary information prior to the patient's visit.
“The algorithm, for the most part, weeds out unnecessary tests, but in some cases it will actually prompt a test based on the patient's history, ensuring it gets ordered if it was missed by the surgeon when completing the form," said Stewart.
“Essentially, it is a double check to ensure the right testing is completed to make sure the patient is going to be safely prepared for surgery, based on the most recent clinical evidence."