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

Area of Science:

• Health Services Research
• Medical Education
• Implementation Science

Background:

• Routine preoperative testing before low-risk surgery is common despite multispecialty recommendations against it.
• De-implementation of unnecessary testing has faced significant challenges.

Purpose of the Study:

• To identify the determinants of unnecessary preoperative testing in low-risk surgical settings.
• To inform strategies for the de-implementation of routine preoperative testing.

Main Methods:

• Focused ethnography was employed at a large academic institution.
• Data collection included semi-structured interviews and direct observations at preoperative evaluation clinics and an outpatient surgery center.
• Narrative thematic analysis was used to identify themes, mapped to the Tailored Implementation for Chronic Diseases (TICD) framework.

Main Results:

• Thirty clinicians (surgeons, anesthesiologists, PCPs, PAs, nurses, MAs) participated.
• Three key themes emerged: Shared Values (prioritizing patient safety, evidence-based medicine), Gaps in Knowledge (regarding testing data and guidelines), and Communication Breakdown (ordering tests based on perceived expectations of other providers).

Conclusions:

• Clinicians exhibit knowledge gaps concerning preoperative testing guidelines, suggesting amenability to educational interventions for de-implementation.
• Consensus guidelines can potentially improve interdisciplinary communication and reduce testing driven by perceived provider expectations.