Targets for De-implementation of Unnecessary Testing Before Low-Risk Surgery: A Qualitative Study.

Autor: Richburg CE; University of Michigan Medical School, Ann Arbor, Michigan; National Institute of Health Short-Term Biomedical Research Training Program, Bethesda, Maryland., Pesavento CM; University of Michigan Medical School, Ann Arbor, Michigan; National Institute of Health Short-Term Biomedical Research Training Program, Bethesda, Maryland., Vastardis A; Department of Surgery, University of Michigan, Ann Arbor, Michigan., Antunez AG; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Gavrila V; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan., Cuttitta A; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan., Nathan H; Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan., Byrnes ME; Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan., Dossett LA; Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan. Electronic address: ldossett@med.umich.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Jan; Vol. 293, pp. 28-36. Date of Electronic Publication: 2023 Sep 11.
DOI: 10.1016/j.jss.2023.07.055
Abstrakt: Introduction: Despite multispecialty recommendations to avoid routine preoperative testing before low-risk surgery, the practice remains common and de-implementation has proven difficult. The goal of this study as to elicit determinants of unnecessary testing before low-risk surgery to inform de-implementation efforts.
Methods: We conducted focused ethnography at a large academic institution, including semi-structured interviews and direct observations at two preoperative evaluation clinics and one outpatient surgery center. Themes were identified through narrative thematic analysis and mapped to a comprehensive and integrated checklist of determinants of practice, the Tailored Implementation for Chronic Diseases framework (TICD).
Results: Thirty individuals participated (surgeons, anesthesiologists, primary care physicians, physician assistants, nurses, and medical assistants). Three themes were identified: (1) Shared Values (TICD Social, Political, and Legal Factors), (2) Gaps in Knowledge (TICD Individual Health Professional Factors, Guideline Factors), and (3) Communication Breakdown (TICD Professional Interactions, Incentives and Resources, Capacity for Organizational Change). Shared Values describe core tenets expressed by all groups of clinicians, namely prioritizing patient safety and utilizing evidence-based medicine. Clinicians had Gaps in Knowledge related to existing data and preoperative testing recommendations. Communication Breakdowns within interdisciplinary teams resulted in unnecessary testing ordered to meet perceived expectations of other providers.
Conclusions: Clinicians have knowledge gaps related to preoperative testing recommendations and may be amenable to de-implementation efforts and educational interventions. Consensus guidelines may streamline interdisciplinary communication by clarifying interdisciplinary needs and reducing testing ordered to meet perceived expectations of other clinicians.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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