Key result
Supplemental ASA preoperative testing guidelines improved the percentage of correct answers by resident physicians in simulated case scenarios (84.2% vs 78.6%; RR 1.07, 95% CI 1.01-1.12, p=0.011).
Why the study?
Does access to supplemental ASA preoperative testing guidelines improve the ability of resident physicians to order appropriate preoperative tests in simulated case scenarios?
RCT (n=66)
randomized
No
Does access to supplemental ASA preoperative testing guidelines improve the ability of resident physicians to order appropriate preoperative tests in simulated case scenarios?
Providing reference guidelines to resident physicians improves their ability to order appropriate preoperative tests in simulated clinical scenarios.
Supports providing supplemental guidelines during resident training; extends evidence on educational tools for appropriate preoperative testing.
Background: Preoperative testing for surgery is estimated to cost $30 billion annually. The goal of this study was to determine the relative influence of access to a guideline reference for preoperative test ordering appropriateness by resident physicians in simulated case scenarios. Methods: At a single teaching hospital, 80 PGY (Post Medical School Graduation Year) 2-5 residents from anesthesiology, surgery, internal medicine, and obstetrics/gynecology were recruited to review simulated case scenarios. Participants within each specialty were randomized with half receiving supplemental ASA preoperative testing guidelines during completion of the questionnaire. Participants indicated which preoperative tests they believed appropriate for each scenario. Correct responses were set by an expert panel and results were reported as relative probabilities and 95% CI. Results: 66 surveys were analyzed. In the entire cohort, the group receiving supplemental guidelines achieved a greater percentage of correct answers (x=84.2%) compared to the group without guidelines (x=78.6%) (relprob =1.07 [CI 1.01-1.12], p=0.011). Correct answers improved to 1.07 [1.01-1.12] with a guideline across specialties and experience levels. Without a guideline, correct answer rates were greater for anesthesia vs surgery residents (1.19 [1.08, 1.31]) and anesthesia vs internal medicine residents (1.16 [1.04, 1.31]). With guidelines, these differences were maintained. Without a guideline, significant differences were noted between PGY 3 vs PGY 2 residents (1.12 [1.03, 1.23]) and PGY 4 vs PGY 2 residents (1.11 [1.03, 1.20]), but these differences were not present with guidelines. Surgery residents did not improve with the guideline. Conclusions: In a set of simulated clinical scenarios, reference to ASA-adapted guidelines improved test ordering by the majority of resident physicians. While anesthesia residents performed better than others independent of the guideline, the guideline negated the effect of experience in non-anesthesia trainees. Given the financial burden of inappropriate preoperative test ordering, further validation of the benefits of guideline implementation is warranted.
No takes yet. Share an insight, caveat, or question.
Andrew Katz (2013) conducted an RCT in Preoperative test ordering (n=66). Supplemental ASA preoperative testing guidelines vs. No guidelines was evaluated on Percentage of correct answers for preoperative test appropriateness (relprob 1.07, 95% CI 1.01-1.12, p=0.011). Supplemental ASA preoperative testing guidelines improved the percentage of correct answers by resident physicians in simulated case scenarios (84.2% vs 78.6%; RR 1.07, 95% CI 1.01-1.12, p=0.011).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: