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Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a
Simone M Kagerbauer1, Jennifer Wißler2, Dimislav I Andonov2
1Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Ulm, Germany.
British Journal of Anaesthesia
|July 6, 2024
Summary
Digital tools for surgical clearance show fair agreement with experts but inadequately consider patient context. Complex guidelines hinder accurate implementation in clinical practice.
Area of Science:
- Anesthesiology
- Medical Informatics
- Clinical Decision Support
Background:
- Guideline adherence in medicine requires improvement.
- Digital decision support tools can enhance compliance.
- Implementing complex medical guidelines into practice is challenging.
Purpose of the Study:
- To evaluate the agreement between a digital guideline support tool and a human expert for surgical clearance.
- To compare digital support and standard practice against expert decisions in patient clearance for surgery.
Main Methods:
- A prospective, single-centre study involving 204 adult patients (ASA physical status 3-4) undergoing elective noncardiac surgery.
- Assessed agreement between a digital guideline support tool, an expert, and on-duty anesthetists' decisions.
- Used a cross-over design to compare the standard approach with expert and digital tool recommendations.
Main Results:
- The expert approach cleared 47.5% of patients, digital support cleared 18.1%, and the standard approach cleared 74.0%.
- Agreement between the expert and digital support was fair (66.7%), as was agreement with the standard approach (67.6%).
- Digital support achieved 50.5% correct clearance versus 44.6% for the standard approach, but both had significant discrepancies in recommending further examinations.
Conclusions:
- Digitalized decision support for surgical clearance may inadequately consider patient individuality and clinical context.
- Vague guideline formulations, weak recommendations, and low-quality evidence impede the translation of guidelines into explicit rules for digital tools.
- Current digital tools require refinement to accurately reflect complex clinical scenarios in surgical clearance.
