Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

Implementation Science

Jeremy M Grimshaw¹  Gregory L Bryson⁴  Jill J Francis²  Rafat Islam³  Andrea M Patey³ 

[1] Faculty of Medicine, University of Ottawa, Smyth Road, Ottawa, ON, Canada;Health Psychology Group and Health Services Research Unit, University of Aberdeen, Foresthill campus, Aberdeen, UK;Centre for Practice-Changing Research, Ottawa Hospital Research Institute – General Campus, Smyth Road, Ottawa, ON, Canada;Department of Anesthesia, The Ottawa Hospital Civic Campus, Ottawa, ON, Canada

关键词: Social influence;    Professional role and identity;    Social;    Content analysis;    Semi-structured interviews;    Theoretical domains framework;    Electrocardiograms;    Chest x-rays;    Surgeons;    Anesthesiologists;    Anesthesia management;    Routine pre-operative testing;   

Others  :  815382
DOI  :  10.1186/1748-5908-7-52

 received in 2011-10-11, accepted in 2012-04-30,  发布年份 2012

【 摘 要 】

Background

Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery.

Methods

Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation.

Results

Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients’ surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation).

Conclusion

We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.

【 授权许可】

   
2012 Patey et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 8.

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