Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic ‘nudges’ into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery

Ahmadi, Alast; Sorensen, Andrea; Villaflores, Chad; Mafi, John N.; Vangala, Sitaram; Hofer, Ira; Bartlett, John; Cheng, Eric M.; Duval, Victor; Damberg, Cheryl L.; Elashoff, David; Goldstein, Noah J.; Ladapo, Joseph A.; Moore, James M.; Pessegueiro, Antonio; Shu, Suzanne B.; Skootsky, Samuel A.; Turner, Ashley; Sarkisian, Catherine A.

doi:10.1136/bmjopen-2021-049568

Cited by 4 publications

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Trials in this area are long overdue. Recently, Ahmadi et al (2021) published a protocol for a randomized superiority trial planning to implement educational messages triggered by preoperative test ordering the EHR [ 52 ]. In Canada, a trial has been registered that aims to reduce preoperative testing for low-risk ambulatory procedures by improving accountability for ordering.…”

Section: Discussionmentioning

confidence: 99%

Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework

et al. 2022

View full text Add to dashboard Cite

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 both health system and health provider factors need to be addressed in an intervention to reduce pre-operative testing.

show abstract

Section: Discussionmentioning

confidence: 99%