Table 3 Summary of belief statements and sample quotes from anesthesiologists, internists, surgeons, and nurse assigned to the theoretical domains identified as not relevant

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