Preoperative assessment of haemostasis in private institutions in France

Preoperative assessment of haemostasis in private institutions in France. Objectives: This study aimed at: i) stating what the routines are regarding ordering of preoperative coagulation test; ii) evaluating the impact on the use of pre-operative orders from the data obtained during the first and the second parts of the study. Study design: Descriptive and comparative epidemiologic study Patients and methods: This study was performed twice, and lasted for one day each during two consecutive years (1998 and 1999). It concerned 22 private clinics in the French region 'Nord-Pas-de-Calais'. The anaesthesiologists who took part in the project had to fill out an easy and brief questionnaire concerning each patient who had been admitted to the operating area. It dealt mainly with the presence or the absence, of a preoperative laboratory screening, and with who ordered the test and which tests. The results of the first part of the study (1998) have been evaluated several times with the involved anaesthesiologists. Before repeating the study in 1999, the results were first discussed and compared to the recommendations of the experts. Results: In 1998, preoperative coagulation tests were ordered for 81% of the patients (n=662), which in more than half the cases were ordered by an anaesthesiologists. In less than 5% of the cases, one or more abnormalities were detected out of which half were predictable because of the patients previous medical history. Only one of the patients in the study suffered from an haemorrhagical problem although he had a normal coagulation screening. A year after, the ordering of a preoperative coagulation check included 75% of the patients (n=400), which represents a small but nonetheless significant decrease of the number of orders compared to 1998 (p < 0.05). The proportion of preoperative laboratory screening prescribed by an anaesthesiologist remained the same. There were one or more abnormalities in 1% of the screening tests that were obtained. A patient had a haemorrhagical problem while she had a normal coagulation screening. Conclusions: In this study, repeated feed-back to the writers of the preoperative orders in the time interval between the two parts of the study did not induce a noticeable decrease in the number of preoperative coagulation tests ordered. The results show the necessity of a different approach to present scientific knowledge in order to modify medical behaviour. (C) 2001 Editions scientifiques et medicales Elsevier SAS.