ArticleBMC health services research2020
Variability in clinicians' understanding and reported methods of identifying high-risk surgical patients: a qualitative study.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines.The British journal of surgery · 2025Observational
- Barriers faced by surgeons in identifying and managing malnutrition in emergency general surgery: A qualitative study.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2024Article
- Predicting Outcomes Following Lower Extremity Endovascular Revascularization Using Machine Learning.Journal of the American Heart Association · 2024Article
- Intensive care utilisation after elective surgery in Australia and New Zealand: A point prevalence study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2024Article
- Does preoperative multidisciplinary team assessment of high-risk patients improve the safety and outcomes of patients undergoing surgery?BMC anesthesiology · 2024Observational
- Preoperative multidisciplinary team decisions for high-risk patients scheduled for noncardiac surgery-a retrospective observational study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2021Observational
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Authors and funding
6 authors.
Funding
Abstract
backgroundHigh-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients.
methodsClinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient's goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the 'constant comparative method' to reveal key themes. Themes concerning patient risk, clinician's understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination.
resultsThirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk: (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians' methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties.
conclusionsAlthough clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians' reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.
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