Document Detail

Implications of rigid adherence to a protocol of investigation for patients undergoing thyroidectomy.
MedLine Citation:
PMID:  18211658     Owner:  NLM     Status:  MEDLINE    
RATIONALE, AIMS AND OBJECTIVES: Protocols may improve patient care by standardizing investigations performed. In pre-operative surgical patients this should ensure all patients undergo essential investigations while limiting unnecessary tests. Previous studies have shown poor protocol adherence within 6 weeks of implementation unless strictly enforced. With this in mind, we analysed clinical and financial implications of rigid adherence to a protocol of pre-operative investigation for patients undergoing thyroidectomy in a single centre. METHODS: A protocol for investigation of patients undergoing thyroidectomy was introduced, with investigations being performed at the surgical out patient clinic. Where already performed by the referring doctor, they were not to be repeated. Protocol adherence was measured over a 6-month period and strictly enforced to try to ensure 100% compliance. RESULTS: 35 consecutive patients underwent thyroidectomy over the study period. Compliance with the protocol was obtained for between 86% and 100% of tests required by the protocol. In addition, numerous tests specified by the protocol were performed more than once, and additional tests outside the protocol were done, with an average excess cost per patient of 121.38 pounds sterling. CONCLUSIONS: A protocol for pre-operative investigation of a common surgical procedure can be achieved. Rigid enforcement of the protocol can lead to over-investigation because of concerns about test omission, with associated financial implications. Furthermore, a rigid protocol does not always prevent performance of unnecessary investigations.
Robert Hardy; Andrew Moss; David Lee
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of evaluation in clinical practice     Volume:  14     ISSN:  1365-2753     ISO Abbreviation:  J Eval Clin Pract     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-23     Completed Date:  2008-03-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9609066     Medline TA:  J Eval Clin Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  145-7     Citation Subset:  IM    
Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Edinburgh, UK.
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MeSH Terms
Clinical Protocols*
Diagnostic Tests, Routine / economics*
Guideline Adherence*
Thyroidectomy / economics*,  standards*
Unnecessary Procedures

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