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- Title
Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing.
- Authors
Harris, Alex H. S.; Finlay, Andrea K.; Hagedorn, Hildi J.; Manfredi, Luisa; Jones, Gabrielle; Kamal, Robin N.; Sears, Erika D.; Hawn, Mary; Eisenberg, Dan; Pershing, Suzann; Mudumbai, Seshadri
- Abstract
Background: Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. Objective: We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. Design: Qualitative study of semi-structured telephone interviews. Participants: We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. Approach: Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. Key Results: Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). Conclusions: We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints.
- Subjects
UNITED States. Veterans Health Administration; OPERATING room nursing; CONSENSUS (Social sciences); PREOPERATIVE education; QUALITATIVE research; VETERANS' health; CATARACT surgery; MEDICAL screening; RESTRAINT of patients
- Publication
JGIM: Journal of General Internal Medicine, 2023, Vol 38, Issue 14, p3209
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-023-08287-0