New practice tool reduces unnecessary testing for surgical patients

Spreading Quality Improvement Initiative project team

​The reduction in preoperative group and screen testing has resulted in 9,000 fewer trips to medical labs at procedural hospitals in the days leading up to surgery and saved the health system $225,000 over three years.

A preoperative group and screen ensures that matched blood is available for patients during surgery and aftercare, and had been recommended traditionally for nearly all surgical procedures. However, many patients do not necessarily require matched blood if the bleeding risk is sufficiently low, minimizing the patient blood and travel needed.

The project team of physicians, nurses and VCH Decision Support has modernized surgical medicine at Vancouver General Hospital (VGH) by creating a practice tool to reduce blood tests. The Transfusion Dashboard enables surgeons, anesthesiologists, perioperative nurses and allied health care staff to use local data and metrics to determine the need to order group and screen tests preoperatively based on the bleeding/transfusion risk of the surgery being booked.

“This quality improvement project has allowed us to deliver high-value innovation for low-value care such as unnecessary tests and procedures that offer little clinical benefit to patients and can misuse limited human and lab resources," says Dr. Jacqueline Trudeau, Anesthesiologist and Project Co-Lead.

Updated regularly, the dashboard empowers clinical staff to make data-driven decisions and to create and monitor best practices that are appropriate for their local patient population.

“A hospital culture that supports medical intervention, including ordering tests appropriately, rationally and efficiently, provides satisfaction to health care workers," says Zeinul Popatia, Registered Nurse. “Most importantly, patients and their family members experience less inconvenience and hardship by avoiding a group and screen when it is deemed unnecessary. This saves people (often from out of town) from having to make an extra trip to VGH, requiring significant travel and time commitment"

Dr. Andrew Shih, Transfusion Medicine Lead Physician at Vancouver Coastal and Project Co-Lead, adds that it takes a lot of energy and resources to deliver clinical services, which can result in a lot of emissions and waste.

“By taking a quality lens, we can reduce the environmental impact we have—as individuals and as a system," he says.

What's next

After successfully optimizing existing resources for elective surgical patients at VGH, the project team is now working to keep patients closer to home to access preoperative care in their local communities across the region. Discussions are underway to spread this project to Richmond General Hospital.

Originally started through the Physician Quality Improvement initiative,
the project is now supported by the 
Spreading Quality Improvement initiative.