Overcoming inertia: Provider perspectives on de-implementation strategies in preoperative testing

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-01-30 DOI:10.1016/j.amjsurg.2025.116228

Erin Kim , Alexis G. Antunez , Devak Nanua , Valerie Gavrila , Anthony Cuttitta , Lesly A. Dossett

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引用次数: 0

Abstract

Background

Routine preoperative testing for low-risk surgeries is often unnecessary and may result in preventable harm. While de-implementation strategies have reduced the frequency and proportion of unnecessary preoperative tests, the reach of the strategies and the provider-level adoption remain unclear. Understanding stakeholders’ perspective on these strategies is essential for widespread de-implementation.

Methods

Interviews were conducted with 18 anesthesiologists, surgeons, and physician assistants at a single academic institution. Thematic analysis was guided by the RE-AIM framework, and persistent barriers were assessed using the Consolidated Framework for Implementation Research.

Results

De-implementation strategies achieved high reach, with educational meetings emerging as the most effective strategy. Workflow variations significantly influenced adoption and implementation, with regular meetings and data sharing identified as facilitators for maintenance. Barriers were identified in the individual characteristics, inner setting, and outer setting levels.

Conclusions

Tailored de-implementation strategies are essential to overcoming provider- and institution-level barriers and to sustain guideline-concordant care.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.