De-implementing Wisely: Using a Theory-based De-implementation Intervention to Reduce Low-value Preoperative Testing in Alberta

Low-value care is defined as a test or treatment for which there is no evidence of patient benefit or where there is evidence of more harm than benefit. Choosing Wisely Canada (CWC) is a professionally led campaign that rallies medical professional to address the issue of low value care. For example, the CWC anaesthesiology recommendations produced by the Canadian Anaesthesiologists' Society recommends against baseline ordering of pre-operative tests.

Whilst the identification of potential areas of low-value care is an important first step in addressing this problem, the issue of implementing Choosing Wisely (CW) like recommendations has not received adequate attention

In the investigators previous study based on the Theoretical Domains Framework (TDF) (REB18-1097), they identified the factors that influence test ordering before low-risk surgical procedures. Barriers identified included conflict about who was responsible for the test-ordering (Social/professional role and identity), inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and Social influences), and logistic problems with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). There were also concerns that not testing might be associated with harms (Beliefs about Consequences). These findings led to the development of a theory-informed intervention that identifies anesthesiologists as primarily responsible for ordering of tests and strengthens accountability within hospitals. The next phase involves evaluating the theory-informed intervention.

The investigators will conduct a cluster randomized controlled trial in 20 hospitals in Alberta, Canada to evaluate whether the theory-based intervention to improve accountability can decrease the use of low-value tests before non-urgent surgery in otherwise healthy patients

Objectives The overall aim of this trial is to evaluate whether a theory-based intervention that addresses barriers and facilitators of persistent low value test ordering reduces low-value preoperative test (ECGs and CXRs) in patients undergoing low risk surgery.