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Targeting Wasteful Preoperative Workup: Benefits of "Big Data" Tools Embedded Within the Epic EHR
Abigail Meyers, Tripp Leavitt
Cleveland Clinic
2024-02-01
Presenter: Abigail Meyers
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Raymond Isakov
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose
Pre-anesthesia testing is ubiquitous for non-emergent surgical patients. Labs are routinely obtained for patients without medical comorbidities undergoing outpatient, elective plastic surgeries, such as breast reduction, gender affirming mastectomy, and septorhinoplasty. Although not clinically indicated in most cases, the 10 most utilized standardized pre-anesthesia testing order sets at our institution include complete blood counts with differentials (CBC+Diff).
Methods
Encounters for pre-anesthesia testing were analyzed using Epic Slicer Dicer from 01/01/2014-12/31/2023. The number of patients who received a CBC, CBC+Diff, or neither were recorded. Total health system costs were calculated based on publicly available cost data.
Results
During the 10-year study period, there were 1,515,526 total preoperative encounters, associated with 263,373 and 142,985 orders for CBC+Diff and CBC respectively. The number of preoperative tests increased year-over-year during this period. Differential blood cell counts represent an estimated 14% cost increase per test, equivalent to $456,894 in excess cost to the health system for 2023. Notably, less than 0.1% revealed abnormalities in differentiated white blood cell distributions.
Conclusion
Over the past ten years, the proportion of patients with CBC+Diffs ordered for pre-anesthesia testing increased, despite the paucity of indications and diminutive rate of abnormal results. This data demonstrates the potential for significant surplus costs related to improper order set design in the electronic medical record (EMR), which may be further compounded across large health systems. Better implementation of institutional evidence-based policies would likely further optimize cost savings and is worthy of additional study.
