Virtual multidisciplinary preoperative assessments: A multi-site formative evaluation and evidence-based guide for implementing change

Introduction: Virtual care has recently gained momentum yet remains underutilized for preoperative assessment. We applied implementation science methodology to the development of a virtual preoperative assessment pathway. Methods: We conducted a two-phase formative evaluation of a multidisciplinary virtual preoperative assessment. In phase 1, we conducted semi-structured interviews with patients, family members, health care providers, and decision makers to explore their experiences and perceptions of virtual care and preoperative assessment. We performed thematic analysis using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to identify factors influencing the implementation of virtual preoperative assessments. In phase 2, evidence-based strategies from the Expert Recommendations for Implementing Change (ERIC) were matched to PARIHS themes and rated for importance and feasibility by stakeholders using Go-Zone analysis. Results: Forty stakeholders were interviewed, including 12 patients or family members, 18 health care providers, and 10 decision makers. Eight themes and 49 subthemes were identified to focus the implementation of virtual preoperative assessment. Twelve implementation strategies were judged to be most important and feasible by stakeholders: develop a formal implementation blueprint, identify early adopters, identify and prepare champions, involve patients and family members, conduct local consensus discussions, build a coalition, develop educational materials, distribute educational materials, prepare patients to be active participants, revise professional roles, re-examine the implementation, and stage implementation scaleup. Discussion: We identified 12 evidence-based strategies to guide the implementation of virtual multidisciplinary preoperative assessments. Our findings can be used to guide implementation of this care innovation in other settings.