Rationale and Design of an Evidence Based Tool to Guide Preoperative Evaluation and Management

In the United States, over testing and over treatment are recognized as the cause of both excess cost and patient harm. Healthcare value (defined as “health outcomes achieved relative to the costs of care”) has become a focus to improve the quality and affordability of healthcare. Perioperative evaluation and management of the surgical patient represents a clear opportunity to improve healthcare value. Herein, we describe the rationale for and the development of a standardized clinical decision support tool that has been distributed to over 600 clinicians performing preoperative evaluations. All patients undergoing this evaluation will be tracked, with the intent to publish both healthcare cost and safety outcomes. The use of a perioperative decision support tool is a unique approach to value in healthcare.