Framework for understanding missed perioperative recommendations

Level	Barrier
Unintentional missed perioperative recommendations
Individual level	Lack of knowledge of the PAC visit note Lack of routine for reviewing PAC visit notes Competing time demands
Systems level	Lack of role clarity No process for double-checking PAC visit recommendations
Intentional missed perioperative recommendations
User error	Lack of ability to implement recommendations Lack of knowledge of evidence or guidelines
Lack of adaptability (appropriate modifications to care plan)	Changed patient status requiring modification of care plan

PAC: pre-admission clinic.

Adapted from: Flemons K, Bosch M, Coakeley S, et al. Barriers and facilitators of following perioperative internal medicine recommendations by surgical teams: a sequential, explanatory mixed-methods study. Perioper Med (Lond) 2022; 11:2. Copyright © 2022 The Authors, published by BioMed Central Ltd. Available at: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-021-00236-x (Accessed on May 25, 2022). Reproduced under the terms of the Creative Commons Attribution License 4.0.

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