De-implementing Low Value Preoperative Care Wisely

NCT05566327 | Unknown

• 1 other identifier: 22-1173
• Study Type: interventional
• Target: 20
• Locations: 0 countries
• Sites: N/A

Brief Summary

Low value preoperative testing does not improve patient outcomes or reduce adverse events. Low value preoperative testing costs patients and healthcare systems without benefit. In a previous study, the investigators identified the systems-level and individual-level drivers of low value preoperative testing. In this study, the investigators will use these drivers of low value testing to design and implement a bundled intervention to reduce low value preoperative testing in Alberta, Canada. The investigators will measure the impact of this intervention on the number of low value tests, adverse events (ICU admissions, length of stay, 30-day readmissions), and patient costs. The investigators will also interview healthcare providers on their experiences with the intervention.

Conditions

Surgery-Complications; Anesthesia Complication

Keywords

Low value preoperative testing; Choosing Wisely CAnada

Outcome Measures

Primary Outcomes (1)

• Low value preoperative testing

  The proportion of patients undergoing one or more low value preoperative test (ECG, echocardiogram, chest x-ray or cardiac stress test) within 60-days of surgery

  1 year

Secondary Outcomes (7)

• Overnight admission

  1 year

• Re-operation

  1 year

• ED Visits

  1 year

• Readmissions

  1 year

• ICU Admission

  1 year

Study Arms (2)

Usual Care

NO INTERVENTION

Clinics in this arm will receive the usual information about low value preoperative testing. Staff at these hospitals may be aware of the Choosing Wisely Anaesthesia Guidelines for reducing unnecessary testing, the Ontario Anaesthesiology Toolkit to operationalize the Choosing Wisely guidelines.

Intervention Group

ACTIVE COMPARATOR

The intervention will focus on increasing accountability for preoperative test ordering to reduce the number of inappropriate tests ordered for patients having ambulatory surgeries. A multi-component approach will be used to address the accountability of who should order preoperative tests for patients undergoing ambulatory surgery.

Behavioral: De-implementation Bundle

Interventions

De-implementation Bundle BEHAVIORAL

A multicomponent intervention directed at the drivers of low value preoperative testing. An administrative change will be implemented whereby medically necessary preoperative tests for patients undergoing scheduled surgery will be ordered at the discretion of a consulting anaesthesiologist only. Workshops will be delivered to surgical, internal medicine, and anaesthesia divisions. The workshop program will include rationale for the policy, discussion of perceived local barriers to implementation and mitigation strategies.The clinical departments will commit to supporting the change in policy. Nurses will be coached to feel comfortable calling the anesthesiologist about any preoperative tests ordered, and the PAC nurses will have the authority to cancel tests. Check boxes will be removed from surgeons' and family physicians' order forms to reduce to ease of ordering the tests.

Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Low risk patient (no cancer, diabetes, or life-limiting disease)
• Undergoing a low-risk surgical procedure (a day surgery or any procedure with a less than 1% 30-day cardiac event or all-cause mortality)
• Adults
• Hospitals in the 26-100th centiles for low value preoperative test ordering

You may not qualify if:

• Has a life-limiting condition
• Pregnancy
• Younger than 18 years

Sponsors & Collaborators

• University of Calgary: lead
• The Ottawa Hospital: collaborator
• Ottawa Hospital Research Institute: collaborator

Central Study Contacts

Yamile Jasaui

CONTACT

403-210-7074; yjasauic@ucalgary.ca

Shannon M Ruzycki, MD

CONTACT

403-210-7370; shannon.ruzycki@ucalgary.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: This is a health services intervention so the intervention and control group will know their allocation. The study team will know the allocation.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Randomized intervention trial

Study Record Dates

• First Submitted: September 29, 2022
• First Posted: October 4, 2022
• Study Start: July 1, 2023
• Primary Completion: December 31, 2023
• Study Completion: January 1, 2025
• Last Updated: May 10, 2023

Record last verified: 2022-09