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

Andrea M Patey, Rafat Islam, Jill J Francis, Gregory L Bryson, Jeremy M Grimshaw, Canada PRIME Plus Team

Research output: Contribution to journalArticle

75 Citations (Scopus)
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Abstract

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.
Original languageEnglish
Pages (from-to)52
JournalImplementation Science
Volume7
DOIs
Publication statusPublished - 9 Jun 2012

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Physicians
Anesthesia
Motivation
Interviews
Surgeons
Anesthesiologists
Professional Role
Ontario
Ambulatory Surgical Procedures
Organizations

Keywords

  • routine pre-operative testing
  • anesthesia management
  • anesthesiologists
  • surgeons
  • chest x-rays
  • electrocardiograms
  • theoretical domains framework
  • semi-structured interviews
  • content analysis
  • social professional role and identity
  • social influence

Cite this

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. / Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M; Canada PRIME Plus Team.

In: Implementation Science, Vol. 7, 09.06.2012, p. 52.

Research output: Contribution to journalArticle

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