Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing

Area of Science:

• Quality Improvement in Healthcare
• Surgical Operations Management
• Evidence-Based Medicine

Background:

• Routine preoperative blood tests and electrocardiograms for low-risk surgery are frequently performed but do not improve patient outcomes.
• These unnecessary tests contribute to wasted resources and potential patient harm.
• Multispecialty organizations recommend against routine preoperative testing for low-risk procedures.

Purpose of the Study:

• To evaluate the effectiveness of a multicomponent deimplementation strategy in reducing low-value preoperative testing.
• The focus was on patients undergoing low-risk general surgery operations.

Main Methods:

• A pre-post quality improvement interventional design was employed.
• The study utilized interrupted time series and difference-in-difference analyses.
• The intervention involved decisional support, stakeholder engagement, education, and consensus building.

Main Results:

• Unnecessary preoperative testing rates decreased significantly over the study periods, with a -16% reduction during the intervention and -27% post-intervention.
• These reductions were observed across different test categories.
• The observed decrease in testing was specific to the study hospital and not seen in other state hospitals.

Conclusions:

• A multicomponent deimplementation strategy effectively reduced unnecessary preoperative testing for low-risk general surgery.
• The intervention demonstrated applicability to common surgical procedures and adaptability for broader clinical settings.
• The findings support the implementation of such strategies to optimize preoperative care and resource utilization.