Abstract
BACKGROUND: Routine preoperative testing for low-risk surgeries is often unnecessary and may result in preventable harm. While de-implementation strategies have reduced the frequency and proportion of unnecessary preoperative tests, the reach of the strategies and the provider-level adoption remain unclear. Understanding stakeholders' perspective on these strategies is essential for widespread de-implementation. METHODS: Interviews were conducted with 18 anesthesiologists, surgeons, and physician assistants at a single academic institution. Thematic analysis was guided by the RE-AIM framework, and persistent barriers were assessed using the Consolidated Framework for Implementation Research. RESULTS: De-implementation strategies achieved high reach, with educational meetings emerging as the most effective strategy. Workflow variations significantly influenced adoption and implementation, with regular meetings and data sharing identified as facilitators for maintenance. Barriers were identified in the individual characteristics, inner setting, and outer setting levels. CONCLUSIONS: Tailored de-implementation strategies are essential to overcoming provider- and institution-level barriers and to sustain guideline-concordant care.