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Doing Pre-operative Investigations in Emergency Department; a Clinical Audit

Muhammad Salman Rafiq, Maria Rafiq, Muhammad Imran Rafiq, Seema Gul Salman, Sania Hafeez




Introduction: Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria.Methods: A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines.Results: A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay.Conclusions: Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay.


Clinical Audit; Management Audit; Emergency Treatment; Emergencies


Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia. 2007;11 (1):13-21.

Kumar M. Overuse of various radiological and pathological investigations: should we be safe or sorry? Journal of family medicine and primary care. 2014;3(2):171.

Czoski-Murray C, Jones ML, McCabe C, Claxton K, Oluboyede Y, Roberts J, et al. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature. 2012.

Miyakis S, Karamanof G, Liontos M, Mountokalakis TD. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgraduate medical journal. 2006;82(974):823-9.

van Heyningen C, Simms P. Guidelines for out-of-hours clinical chemistry investigations. Clinical chemistry. 1990;36(12):2151-2.

Pennycook A. Are blood tests of value in the primary assessment and resuscitation of patients in the A&E department? Postgraduate medical journal. 1995;71(832):81-5.

Excellence NIfC, Britain G. Preoperative tests: the use of routine preoperative tests for elective surgery: National Institute for Clinical Excellence; 2003.

Brophy JM. Multicenter trials, guidelines, and uncertainties—Do we know as much as we think we do? International journal of cardiology. 2015;187:600-3.

Islam A. Health sector reform in Pakistan: why is it needed? JPMA The Journal of the Pakistan Medical Association. 2002;52(3):95-100.

Weiss ES, Cornwell EE, Wang T, Syin D, Millman EA, Pronovost PJ, et al. Human immunodeficiency virus and hepatitis testing and prevalence among surgical patients in an urban university hospital. The American journal of surgery. 2007;193(1):55-60.

DOI: http://dx.doi.org/10.22037/emergency.v5i1.11075

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