Dataset Information

Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.

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.

SUBMITTER: Kagerbauer SM

PROVIDER: S-EPMC11347788 | biostudies-literature | 2024 Sep

REPOSITORIES: biostudies-literature

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Publications

Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.

Kagerbauer Simone M SM Wißler Jennifer J Andonov Dimislav I DI Ulm Bernhard B Schneider Gerhard G Podtschaske Armin H AH Blobner Manfred M Jungwirth Bettina B

British journal of anaesthesia 20240705 3

<h4>Background</h4>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.<h4>Methods</h4>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 guide ...[more]

PMID: 38971713

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Dataset Information

Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.

Background

Methods

Results

Conclusions

Clinical trial registration

Publications

Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.

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