Why Do Physicians Order Unnecessary Preoperative Tests? A Qualitative Study

BACKGROUND: Routine preoperative testing is ineffective and costly. We explored reasons for the continued use of unnecessary preoperative tests and approaches to limit such testing. METHODS: We interviewed 23 physicians and nurse administrators involved in preoperative decision-making in our local health care environment. We conducted interviews using a semi-structured format and analyzed the data using a template organizing style. RESULTS: Some interviewees feel routine preoperative tests are beneficial, others are ambivalent about preoperative tests in their practice, and many believe there is considerable unnecessary testing. As interviewees discussed factors that lead to the ordering of unnecessary preoperative tests, five major themes emerged: practice tradition, belief that other physicians want the tests done, medicolegal worries, concerns about surgical delays or cancellation, and lack of awareness of evidence and guidelines. Interviewees suggested that a consensus guideline, improved education, and increased collaboration between specialities could decrease unnecessary testing. CONCLUSIONS: Our qualitative findings demonstrate barriers to limiting unnecessary preoperative testing but also suggest interventions that could improve the preoperative testing process. Minimizing unnecessary preoperative tests could decrease cost, maximize quality, and improve the patient experience.