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Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.
Kagerbauer, Simone M; Wißler, Jennifer; Andonov, Dimislav I; Ulm, Bernhard; Schneider, Gerhard; Podtschaske, Armin H; Blobner, Manfred; Jungwirth, Bettina.
Afiliación
  • Kagerbauer SM; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Ulm, Germany.
  • Wißler J; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
  • Andonov DI; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
  • Ulm B; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Ulm, Germany.
  • Schneider G; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
  • Podtschaske AH; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
  • Blobner M; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Ulm, Germany. Electronic address: m.blobner@tum.de.
  • Jungwirth B; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Ulm, Germany.
Br J Anaesth ; 133(3): 519-529, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38971713
ABSTRACT

BACKGROUND:

Guideline adherence in the medical field leaves room for improvement. Digitalised decision support helps improve compliance. However, the complex nature of the guidelines makes implementation in clinical practice difficult.

METHODS:

This single-centre prospective study included 204 adult ASA physical status 3-4 patients undergoing elective noncardiac surgery at a German university hospital. Agreement of clearance for surgery between a guideline expert and a digital guideline support tool was investigated. The decision made by the on-duty anaesthetists (standard approach) was assessed for agreement with the expert in a cross-over design. The main outcome was the level of agreement between digital guideline support and the expert.

RESULTS:

The digital guideline support approach cleared 18.1% of the patients for surgery, the standard approach cleared 74.0%, and the expert approach cleared 47.5%. Agreement of the expert decision with digital guideline support (66.7%) and the standard approach (67.6%) was fair (Cohen's kappa 0.37 [interquartile range 0.26-0.48] vs 0.31 [0.21-0.42], P=0.6). Taking the expert decision as a benchmark, correct clearance using digital guideline support was 50.5%, and correct clearance using the standard approach was 44.6%. Digital guideline support incorrectly asked for additional examinations in 31.4% of the patients, whereas the standard approach did not consider conditions that would have justified additional examinations before surgery in 29.4%.

CONCLUSIONS:

Strict guideline adherence for clearance for surgery through digitalised decision support inadequately considered patients, clinical context. Vague formulations, weak recommendations, and low-quality evidence complicate guideline translation into explicit rules. CLINICAL TRIAL REGISTRATION NCT04058769.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Preoperatorios / Adhesión a Directriz Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Anaesth Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Preoperatorios / Adhesión a Directriz Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Anaesth Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido