Implementing a closed loop clinical decision support system for sustainable preoperative care.

Summary

A fully EHR-integrated closed-loop CDSS for preprocedural testing reduced chest X-rays by ~83%, ECGs by ~54%, blood typing by ~50%, and preop blood test panels by ~29% across 228,671 procedures, with €1.0M in savings and no increase in cancellations or adverse postoperative outcomes.

Key Findings

• Chest X-ray orders decreased by ~83% after CDSS implementation (p<0.001).
• ECG orders fell by ~54%, blood type testing by ~50%, and preop blood test panels by ~29%.
• Estimated cost savings were €1,013,666 with no increase in same-day cancellations or postoperative adverse events.

Clinical Implications

Health systems can embed closed-loop CDSS within EHRs to automate appropriate test ordering, reduce unnecessary preop testing, and cut costs without compromising safety.

Limitations

• Quasi-experimental design susceptible to secular trends and unmeasured confounding.
• Conducted in two teaching hospitals in one region, which may limit generalizability.

Future Directions

Multicentre deployments with randomized or stepped-wedge designs; assess patient-centred outcomes and sustainability metrics (e.g., carbon footprint) alongside cost and safety.