Reducing Unnecessary Type and Screens Prior to Thoracic Surgery: A Quality Improvement Initiative

Introduction: Previous work identified that routine preoperative type and screen (T & S) testing before elective thoracic surgery is overutilized. We hypothesized that instituting a quality improvement (QI) initiative to change practice would significantly reduce this un-necessary testing, reduce costs, and improve healthcare efficiency. Materials and methods: A QI initiative was developed at a single, academic center to reduce empiric T & S ordering before elective anatomic lung resections. Two interventions were implemented: 1) education based on current institutional data and 2) an electronic medical record order set modification. Utilization of T & S testing, blood transfusion data, and perioperative outcomes were tracked and compared between a preintervention group (2015-2018) and a postintervention group (2020-2021). Cost data were derived from insti-tutional charges and Centers for Medicare & Medicaid Services fee schedules.Results: Of the 553 patients included: 420 were in the preintervention group and 133 were in the postintervention group. The rate of routine T & Ss significantly dropped after imple-menting the QI initiative (97 versus 20%, P < 0.001). Additionally, no difference in blood transfusion rate was observed (4.3 versus 2.3%, P = 0.29), and there were no differences noted in postoperative complications (P = 0.82), 30-day readmission (P = 0.29), or mortality (P = 0.96). Based on current volumes of-200 anatomic lung resections/year, estimated cost savings from reducing T & S testing from 97 to 20% would be at least $40,000 a year.Conclusions: Our QI initiative significantly reduced the use of routine T & S testing. This practice change was achieved while maintaining excellent outcomes demonstrating routine preoperative T & S testing can be safely reduced in most elective thoracic surgery.& COPY; 2022 Published by Elsevier Inc.