Perceived Barriers to the De-implementation of Routine Preoperative History & Physicals Preceding Low-Risk Ambulatory Procedures: A Qualitative Study of Surgeon Perspectives

Reducing unnecessary preoperative testing

“…For example, surgeons often ordered low value preoperative investigations because they anticipated that the anaesthesiologist wanted these results, and anaesthesiologists were reluctant to cancel these tests because they had been ordered by the surgeon. This barrier has been demonstrated in other studies 28. Further, surgeons and anaesthesiologists felt that the risks of not ordering investigations, even if rare or unlikely, (such as patient harm or surgical cancellations) were greater than the consequences of ordering these tests (such as cost or care cascades resulting in additional tests or specialty consultations), suggesting that over-testing is rooted in the general misconception that medical screening cannot be harmful.…”

Anesthesiologists Are Integral to Value-Based Surgical Care Reform —Reply

“…Qualitative work in this area suggests routine preoperative testing may be ordered based on false beliefs the testing is needed by another health care professional . Specifically, surgeons admit they order preoperative testing they believed anesthesiologists needed . Given anesthesiologists hold significant power over whether a case is delayed or canceled, surgeons may fear case cancellation by anesthesiologists if preoperative testing is not complete.…”

“…Given anesthesiologists hold significant power over whether a case is delayed or canceled, surgeons may fear case cancellation by anesthesiologists if preoperative testing is not complete. On the other hand, anesthesiologists do not cancel preoperative testing orders given the surgeon ordered them . Anesthesiologists frequently do not partake in preoperative evaluation for low-risk patients before surgery, so they have little incentive to get involved in placing (or not placing) the preoperative testing orders initially.…”