Reducing Low-Value Preoperative Investigations in Patients Undergoing Low Risk Surgery

NCT05526495 | Unknown

• 1 other identifier: Reducing Low-Value Pre-Op
• Study Type: interventional
• Target: 22
• Locations: 1 country
• Sites: 4

Brief Summary

The purpose of this study is to evaluate if a multi-component behavioral intervention given to anesthesiologists and surgeons is associated with decreasing low value preoperative testing orders in patients undergoing low risk surgery. The objectives of this trial are to evaluate a) the overall rate of low-value preoperative test (electrocardiogram and chest X-ray) in patients undergoing low risk surgery, b) to conduct an economic and c) process evaluation of the implementation The investigators will assess these outcomes in a sample of 22 Hospitals in Ontario, Canada.

Conditions

Surgery; Anesthesiology

Keywords

Electrocardiographs; Preoperative testing; Chest X-rays; Low Risk Surgical Procedures

Outcome Measures

Primary Outcomes (1)

• Pre-operative testing

  Proportion of patients receiving one or more low-value preoperative tests within 60 days before surgery

  within 60 days before surgery

Secondary Outcomes (7)

• Overnight admission

  within 24 hours from the date of surgery

• Re-operation events

  within 24 hours

• All-cause mortality

  30-day from the date of surgery

• Preoperative tests

  6 months

• Mechanistic sub-study

  6 months

Study Arms (2)

De-implementation

EXPERIMENTAL

A multi-behaviour technique will be used along with theoretical domains framework. Clinicians will be provided with continuing multi-behaviour component intervention to increase accountability for preoperative test ordering in patients having low risk surgeries.

Behavioral: Reducing preoperative low-value test ordering

Comparator

NO INTERVENTION

Standard of care

Interventions

Reducing preoperative low-value test ordering BEHAVIORAL

A multi-component approach will be used:1) An administrative change will be implemented whereby medically necessary preoperative tests for patients undergoing non-urgent surgery will be ordered at the discretion of an anesthesiologist based on their clinical assessment. Adoption of the policy change will be facilitated by a local champion using an engagement and education program for anesthesiologists, surgeons, pre-admission clinic nurses and administrative staff; 2) The workshop program will include rationale for the policy, discussion of perceived local barriers to implementation and mitigation strategies. A train-the-trainer model will be used; 3) The departments will commit to supporting the change in policy. Nurses within preoperative clinic will be coached to feel comfortable calling the anesthesiologist about any pre-op tests ordered, and the Pre-Admission Unit will have the authority to cancel tests that deem unnecessary. Check boxes will be removed from medical order forms

De-implementation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may not qualify if:

• emergency elective chest X-rays and/or electrocardiogram

Sponsors & Collaborators

• Ottawa Hospital Research Institute: lead
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (4)

Muskoka Algonquin Healthcare

Muskoka, Onario, Canada

RECRUITING

Grand River Hospital

Kitchener, Ontario, Canada

RECRUITING

St.Joseph'S Health Care

London, Ontario, Canada

RECRUITING

Stratford General Hospital

Stratford, Ontario, Canada

RECRUITING

Related Publications (3)

• Grimshaw JM, Patey AM, Kirkham KR, Hall A, Dowling SK, Rodondi N, Ellen M, Kool T, van Dulmen SA, Kerr EA, Linklater S, Levinson W, Bhatia RS. De-implementing wisely: developing the evidence base to reduce low-value care. BMJ Qual Saf. 2020 May;29(5):409-417. doi: 10.1136/bmjqs-2019-010060. Epub 2020 Feb 6.

  PMID: 32029572 BACKGROUND

• Kirkham KR, Wijeysundera DN, Pendrith C, Ng R, Tu JV, Laupacis A, Schull MJ, Levinson W, Bhatia RS. Preoperative testing before low-risk surgical procedures. CMAJ. 2015 Aug 11;187(11):E349-E358. doi: 10.1503/cmaj.150174. Epub 2015 Jun 1.

  PMID: 26032314 BACKGROUND

• Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM; Canada PRIME Plus Team. 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. Implement Sci. 2012 Jun 9;7:52. doi: 10.1186/1748-5908-7-52.

  PMID: 22682612 BACKGROUND

Study Officials

• Jeremy Grimshaw, PhD

  Ottawa Hospital Research Institute

  STUDY DIRECTOR

• Kyle Kirkham, MD

  Department of Anaesthesia, Toronto Western Hospital, University of Toronto

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Alfonso Ortiz, MSc

CONTACT

613-929-8423; lortiz@ohri.ca

Andrea Patey, PhD

CONTACT

apatey@ohri.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Scientist

Model Details: Eligible hospitals (cluster) within the 26-100th centile for routine preoperative tests will be parallel randomized into two study arms.

Study Record Dates

• First Submitted: August 5, 2022
• First Posted: September 2, 2022
• Study Start: January 1, 2024
• Primary Completion: January 1, 2025
• Study Completion: March 31, 2025
• Last Updated: November 1, 2023

Record last verified: 2023-10

Data Sharing

• IPD Sharing: Will not share

Locations

CA (4)