EHR-integrated clinical decision support reduces unnecessary preoperative tests

Editor's Note

An EHR-integrated closed-loop clinical decision support system (CDSS) significantly reduced unnecessary preoperative testing, improved patient safety, and significantly reduced costs across two hospitals in Madrid, Spain. As detailed in a study published January 3 in npj digital medicine, this system demonstrates the potential of automated guidelines to optimize preoperative care.

Researchers analyzed 228,671 surgical cases over 69 months, including 78,388 procedures pre-implementation and 150,283 post-implementation. By integrating the CDSS into the electronic health record, test orders were automatically generated based on patient characteristics and surgical risk, with clinician oversight for manual adjustments.

Results show reductions for orders across a variety of procedures, including:

• Chest X-rays, an 83% reduction
• Electrocardiograms, a 54% reduction
• Blood-type testing, a 50% reduction
• Other preoperative blood tests, a 29% reduction

Authors report no increase in surgical cancellations or adverse events. In fact, the hospitals experienced slight reductions in postoperative sepsis (0.2% to 0.08%) and early reintervention rates (3.16% to 2.54%).  The system also reduced same-day cancellations due to incomplete preoperative workups.