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Effective Deimplementation of Low-Value Preoperative Testing: Choosing Wisely, From Policy to Practice.
JAMA Surg
January 2025
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin.
Importance: Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.
Objective: To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.
Synthesizing evidence to guide the design and implementation of effective strategies for discontinuing postoperative antibiotic prophylaxis in surgical settings: an umbrella review post-WHO 2018 recommendations.
Syst Rev
January 2025
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania.
Background: Postoperative antibiotic prophylaxis (PAP) involves using antibiotics after surgery to prevent surgical site infections (SSIs). However, studies have shown that PAP offers no additional benefits compared to discontinuation after surgical incision closure, prompting its de-implementation to prevent unnecessary antibiotic use that may contribute to antibiotic resistance. We conducted this review to synthesize evidence for guiding the design and implementation of effective strategies for discontinuing PAP practice and optimizing antibiotic use in surgical settings.
View Article and Find Full Text PDFDevelopment and usability testing of a multifaceted intervention to reduce low-value injury care.
BMC Health Serv Res
January 2025
Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1401, 18e rue, Québec, Qc, Canada.
Background: Multifaceted interventions that address barriers and facilitators have been shown to be most effective for increasing the adoption of high-value care, but there is a knowledge gap on this type of intervention for the de-implementation of low-value care. Trauma is a high-risk setting for low-value care, such as unnecessary diagnostic imaging and the use of specialized resources. The aim of our study was to develop and assess the usability of a multifaceted intervention to reduce low-value injury care.
View Article and Find Full Text PDFFive-year sustainability of a de-implementation strategy to reduce inappropriate use of catheters: a multicentre, mixed-methods study.
EClinicalMedicine
September 2024
Amsterdam UMC, University of Amsterdam, Department of Internal Medicine-Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health, the Netherlands.
Background: The use of peripheral intravenous catheters (PIVCs) contributes to healthcare-associated infections. In 2017, we implemented a multifaceted de-implementation strategy that successfully reduced the inappropriate use of catheters in seven hospitals in the Netherlands (RICAT-1 study). Five years later, we investigated the sustainability of this strategy and the contributing factors.
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