Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework
Introduction While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelin...
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ftdoajarticles:oai:doaj.org/article:bbc913a2adda425295f925e3d99b70de 2023-05-15T17:22:46+02:00 Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework Amanda Hall Andrea Pike Andrea Patey Sameh Mortazhejri Samantha Inwood Shannon Ruzycki Kyle Kirkham Krista Mahoney Jeremy Grimshaw 2022-01-01T00:00:00Z https://doaj.org/article/bbc913a2adda425295f925e3d99b70de EN eng Public Library of Science (PLoS) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731462/?tool=EBI https://doaj.org/toc/1932-6203 1932-6203 https://doaj.org/article/bbc913a2adda425295f925e3d99b70de PLoS ONE, Vol 17, Iss 12 (2022) Medicine R Science Q article 2022 ftdoajarticles 2022-12-30T22:26:01Z Introduction While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelines into clinical practice can be challenging and it is important to understand what is driving behaviour when developing interventions to change it. Aim Thus, we completed a theory-based investigation of the perceived barriers and enablers to reducing unnecessary preoperative tests for low-risk surgical procedures in Newfoundland, Canada. Method We used snowball sampling to recruit surgeons, anaesthesiologists, or preoperative clinic nurses. Interviews were conducted by two researchers using an interview guide with 31 questions based on the theoretical domains framework. Data was transcribed and coded into the 14 theoretical domains and then themes were identified for each domain. Results We interviewed 17 surgeons, anaesthesiologists, or preoperative clinic nurses with 1 to 34 years’ experience. Overall, while respondents agreed with the guidelines they described several factors, across seven relevant theoretical domains, that influence whether tests are ordered. The most common included uncertainty about who is responsible for test ordering, inability to access patient records or to consult/communicate with colleagues about ordering decisions and worry about surgery delays/cancellation if tests are not ordered. Other factors included workplace norms that conflicted with guidelines and concerns about missing something serious or litigation. In terms of enablers, respondents believed that clear institutional guidelines including who is responsible for test ordering and information about the risk of missing something serious, supported by improved communication between those involved in the ordering process and periodic evaluation will reduce any unnecessary preoperative testing. Conclusion These findings suggest that ... Article in Journal/Newspaper Newfoundland Directory of Open Access Journals: DOAJ Articles Canada |
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topic |
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Medicine R Science Q Amanda Hall Andrea Pike Andrea Patey Sameh Mortazhejri Samantha Inwood Shannon Ruzycki Kyle Kirkham Krista Mahoney Jeremy Grimshaw Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
topic_facet |
Medicine R Science Q |
description |
Introduction While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelines into clinical practice can be challenging and it is important to understand what is driving behaviour when developing interventions to change it. Aim Thus, we completed a theory-based investigation of the perceived barriers and enablers to reducing unnecessary preoperative tests for low-risk surgical procedures in Newfoundland, Canada. Method We used snowball sampling to recruit surgeons, anaesthesiologists, or preoperative clinic nurses. Interviews were conducted by two researchers using an interview guide with 31 questions based on the theoretical domains framework. Data was transcribed and coded into the 14 theoretical domains and then themes were identified for each domain. Results We interviewed 17 surgeons, anaesthesiologists, or preoperative clinic nurses with 1 to 34 years’ experience. Overall, while respondents agreed with the guidelines they described several factors, across seven relevant theoretical domains, that influence whether tests are ordered. The most common included uncertainty about who is responsible for test ordering, inability to access patient records or to consult/communicate with colleagues about ordering decisions and worry about surgery delays/cancellation if tests are not ordered. Other factors included workplace norms that conflicted with guidelines and concerns about missing something serious or litigation. In terms of enablers, respondents believed that clear institutional guidelines including who is responsible for test ordering and information about the risk of missing something serious, supported by improved communication between those involved in the ordering process and periodic evaluation will reduce any unnecessary preoperative testing. Conclusion These findings suggest that ... |
format |
Article in Journal/Newspaper |
author |
Amanda Hall Andrea Pike Andrea Patey Sameh Mortazhejri Samantha Inwood Shannon Ruzycki Kyle Kirkham Krista Mahoney Jeremy Grimshaw |
author_facet |
Amanda Hall Andrea Pike Andrea Patey Sameh Mortazhejri Samantha Inwood Shannon Ruzycki Kyle Kirkham Krista Mahoney Jeremy Grimshaw |
author_sort |
Amanda Hall |
title |
Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
title_short |
Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
title_full |
Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
title_fullStr |
Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
title_full_unstemmed |
Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework |
title_sort |
barriers to reducing preoperative testing for low-risk surgical procedures: a qualitative assessment guided by the theoretical domains framework |
publisher |
Public Library of Science (PLoS) |
publishDate |
2022 |
url |
https://doaj.org/article/bbc913a2adda425295f925e3d99b70de |
geographic |
Canada |
geographic_facet |
Canada |
genre |
Newfoundland |
genre_facet |
Newfoundland |
op_source |
PLoS ONE, Vol 17, Iss 12 (2022) |
op_relation |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731462/?tool=EBI https://doaj.org/toc/1932-6203 1932-6203 https://doaj.org/article/bbc913a2adda425295f925e3d99b70de |
_version_ |
1766109621548744704 |