From: Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing
Domains | Specific belief | Sample quote | Frequency out of 16 |
---|---|---|---|
Skills | Experience improves clinical skills/competence to perform preoperative assessments/order tests appropriately | “Because of years experience and also understanding the statistics around low-risk surgery that most patients are very low risk for low-risk surgery unless they have some major complications. […] So, understanding that through the experience, plus understanding the evidence around it.” (I2) | 10 |
Memory, attention, and decision processes | The decision to order/not order tests is based on patients’ history, physical exam, and medical condition | “I guess the main thing that is, as I said, the main thing that this finds, if I’m ordering a test or not is the history and physical exam and if there is a new symptom or physical exam finding that wasn’t there before, that’s what defines if I’m ordering a test or not in the setting of a low-risk procedure.” (A2) | 14 |
Emotions | My emotions do not influence whether or not I order ECGs/CXRs | “No. None. [managing a patient without ordering ECGs or chest x-rays evokes worry or concern]” (S1) | 15 |
Behavioral regulation | Having clear decision tools/algorithms to streamline the process could reduce/reduces unnecessary testing | “…Strictly adhering to the guidelines, it could be something that could be done on a computer, maybe just obviously I think you would want to have probably a person just kind of reviewing maybe for each patient to make sure that what the computer suggested actually is appropriate. […] That would be very guideline driven and doesn’t need to be done by a physician. It could be done almost by a computer if you think about it. I guess in a perfect world, I think we as a system would benefit by being a bit more rigorous and structured in application of the guidelines through use of algorithms.” (I2) | 7 |