Gracia Martínez José Luis, Pfang Bernadette, Morales Coca Miguel Ángel, Caramés Sánchez Cristina, Del Olmo Rodríguez Marta, Villegas García Marco Antonio, Short Apellaniz Jorge, Arcos Campillo Javier, Álvaro de la Parra Juan Antonio, Manzano Lorefice Florencia, Muñoz Alameda Luis Enrique
Anesthesiology Department, General Villalba University Hospital, Madrid, Spain.
Clinical and Organizational Innovation Department (UICO), Madrid, Spain.
NPJ Digit Med. 2025 Jan 3;8(1):6. doi: 10.1038/s41746-024-01371-7.
Unnecessary preoperative testing poses a risk to patient safety, causes surgical delays, and increases healthcare costs. We describe the effects of implementing a fully EHR-integrated closed-loop clinical decision support system (CDSS) for placing automatic preprocedural test orders at two teaching hospitals in Madrid, Spain. Interrupted time series analysis was performed to evaluate changes in rates of preoperative testing after CDSS implementation, which took place from September 2019 to December 2019. We included 228,671 surgical procedures during a 69-month period from January 1st, 2018, to October 1st, 2023, of which 78,388 were from the preintervention period and 150,283 from the postimplementation period. We observed a significant reduction (p < 0.001) of 83% (-83.4% to -83.1%) for chest X-ray orders, 54% (-54.7% to -54.2%) for ECG orders, 50% for blood type testing (-50.5% to -50.1%), and 29% (-29.5% to -29.0%) for preoperative blood test order sets, leading to overall cost-savings of €1,013,666. No increase in postoperative adverse events or same-day cancellations was observed. Our results demonstrate that an EHR-embedded closed-loop CDSS can reduce avoidable preoperative testing without increasing surgical cancelations, postoperative adverse events, or early re-interventions, thus improving the quality of care and healthcare expenditure.
不必要的术前检查对患者安全构成风险，导致手术延迟，并增加医疗成本。我们描述了在西班牙马德里的两家教学医院实施一个完全集成电子健康记录的闭环临床决策支持系统（CDSS）以自动下达术前检查医嘱的效果。进行了中断时间序列分析，以评估2019年9月至2019年12月实施CDSS后术前检查率的变化。我们纳入了2018年1月1日至2023年10月1日69个月期间的228,671例外科手术，其中78,388例来自干预前期，150,283例来自实施后期。我们观察到胸部X光检查医嘱显著减少83%（-83.4%至-83.1%，p<0.001），心电图检查医嘱减少54%（-54.7%至-54.2%），血型检测减少50%（-50.5%至-50.1%），术前血液检查套餐减少29%（-29.5%至-29.0%），从而节省了总计1,013,666欧元的成本。未观察到术后不良事件或当日取消手术的情况增加。我们的结果表明，嵌入电子健康记录的闭环CDSS可以减少可避免的术前检查，而不会增加手术取消率、术后不良事件或早期再次干预，从而提高医疗质量和医疗支出。
