TY - JOUR
T1 - Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation
T2 - a prospective agreement study
AU - Kagerbauer, Simone M.
AU - Wißler, Jennifer
AU - Andonov, Dimislav I.
AU - Ulm, Bernhard
AU - Schneider, Gerhard
AU - Podtschaske, Armin H.
AU - Blobner, Manfred
AU - Jungwirth, Bettina
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/9
Y1 - 2024/9
N2 - Background: Guideline adherence in the medical field leaves room for improvement. Digitalised decision support helps improve compliance. However, the complex nature of the guidelines makes implementation in clinical practice difficult. Methods: This single-centre prospective study included 204 adult ASA physical status 3–4 patients undergoing elective noncardiac surgery at a German university hospital. Agreement of clearance for surgery between a guideline expert and a digital guideline support tool was investigated. The decision made by the on-duty anaesthetists (standard approach) was assessed for agreement with the expert in a cross-over design. The main outcome was the level of agreement between digital guideline support and the expert. Results: The digital guideline support approach cleared 18.1% of the patients for surgery, the standard approach cleared 74.0%, and the expert approach cleared 47.5%. Agreement of the expert decision with digital guideline support (66.7%) and the standard approach (67.6%) was fair (Cohen's kappa 0.37 [interquartile range 0.26–0.48] vs 0.31 [0.21–0.42], P=0.6). Taking the expert decision as a benchmark, correct clearance using digital guideline support was 50.5%, and correct clearance using the standard approach was 44.6%. Digital guideline support incorrectly asked for additional examinations in 31.4% of the patients, whereas the standard approach did not consider conditions that would have justified additional examinations before surgery in 29.4%. Conclusions: Strict guideline adherence for clearance for surgery through digitalised decision support inadequately considered patients, clinical context. Vague formulations, weak recommendations, and low-quality evidence complicate guideline translation into explicit rules. Clinical trial registration: NCT04058769.
AB - Background: Guideline adherence in the medical field leaves room for improvement. Digitalised decision support helps improve compliance. However, the complex nature of the guidelines makes implementation in clinical practice difficult. Methods: This single-centre prospective study included 204 adult ASA physical status 3–4 patients undergoing elective noncardiac surgery at a German university hospital. Agreement of clearance for surgery between a guideline expert and a digital guideline support tool was investigated. The decision made by the on-duty anaesthetists (standard approach) was assessed for agreement with the expert in a cross-over design. The main outcome was the level of agreement between digital guideline support and the expert. Results: The digital guideline support approach cleared 18.1% of the patients for surgery, the standard approach cleared 74.0%, and the expert approach cleared 47.5%. Agreement of the expert decision with digital guideline support (66.7%) and the standard approach (67.6%) was fair (Cohen's kappa 0.37 [interquartile range 0.26–0.48] vs 0.31 [0.21–0.42], P=0.6). Taking the expert decision as a benchmark, correct clearance using digital guideline support was 50.5%, and correct clearance using the standard approach was 44.6%. Digital guideline support incorrectly asked for additional examinations in 31.4% of the patients, whereas the standard approach did not consider conditions that would have justified additional examinations before surgery in 29.4%. Conclusions: Strict guideline adherence for clearance for surgery through digitalised decision support inadequately considered patients, clinical context. Vague formulations, weak recommendations, and low-quality evidence complicate guideline translation into explicit rules. Clinical trial registration: NCT04058769.
KW - digital guideline support
KW - elective noncardiac surgery
KW - guideline adherence
KW - preoperative evaluation
KW - software-based decision-support
UR - http://www.scopus.com/inward/record.url?scp=85197606293&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2024.06.001
DO - 10.1016/j.bja.2024.06.001
M3 - Article
AN - SCOPUS:85197606293
SN - 0007-0912
VL - 133
SP - 519
EP - 529
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -