12 Jun Despite Guidelines, Many Physicians Still Ordering Routine Preoperative Tests

MedicalResearch.com Interview with:
Joseph A. Ladapo, MD, PhD
Assistant Professor of Medicine
Section on Value and Effectiveness
Department of Population Health
NYU Langone School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Ladapo: Routine tests before elective surgery are largely considered to be of low value, and they may also increase costs.  In an attempt to discourage their use, two professional societies released guidance on use of routine preoperative testing in 2002. We sought to examine the long-term national effect of these guidelines from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians’ use of routine preoperative testing. While we found that overall rates of routine testing declined across several categories over the 14-year study period, these changes were not significant after accounting for overall changes in physicians’ ordering practices. Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice.

Medical Research: What should clinicians and patients take away from your report?

Dr. Ladapo: While it’s important to ensure patients can safely undergo surgical procedures, many of these procedures are low-risk, and the tests rarely improve patient management. Clinicians are responsible for reducing these low-value tests, and this harkens all the way back to residency training.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ladapo: While the evidence suggests that physicians are not readily adopting the published guidelines, we don’t know why. Research that informs how to facilitate greater adherence to evidence-based guidelines should significantly improve quality of care.

Citation:

Sigmund AE, Stevens ER, Blitz JD, Ladapo JA. Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance . JAMA Intern Med. Published online June 08, 2015. doi:10.1001/jamainternmed.2015.2081.

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Joseph A. Ladapo, MD, PhD, Assistant Professor of Medicine, Section on Value and Effectiveness, Department of Population Health, & NYU School of Medicine (2015). Despite Guidelines, Many Physicians Still Ordering Routine Preoperative Tests 

Last Updated on April 6, 2016 by Marie Benz MD FAAD