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Related Experiment Video

Updated: Sep 11, 2025

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Scaling Smarter Preoperative Testing: A Multisite Evaluation of Adaptations to De-implementation Strategy Using

Erin Kim1, Nicole M Mott2, Dana Greene3

  • 1University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.

The Journal of Surgical Research
|August 14, 2025
PubMed
Summary
This summary is machine-generated.

Adapting the Right-Sizing Testing Before Elective Surgery intervention to different hospitals reduced unnecessary preoperative tests. Tailoring strategies maintained the intervention's core while aligning with local needs, improving healthcare efficiency.

Keywords:
Audit and feedbackDeimplementationFRAME-ISImplementation scienceLow-value carePreoperative testingQuality improvement

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Area of Science:

  • Implementation Science
  • Healthcare Management
  • Surgical Optimization

Background:

  • Unnecessary preoperative testing leads to increased healthcare costs, care cascades, and surgical delays.
  • The Right-Sizing Testing Before Elective Surgery intervention aims to reduce low-value preoperative testing.
  • Understanding intervention adaptability is crucial for de-implementation across diverse healthcare settings.

Purpose of the Study:

  • To apply the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) to track modifications.
  • To analyze site-specific adaptations of a multicomponent intervention for reducing preoperative testing.
  • To understand how de-implementation strategies can be tailored to varied healthcare environments.

Main Methods:

  • Piloted the Right-Sizing Testing Before Elective Surgery intervention at three Michigan hospitals (March-August 2024).
  • Intervention components included site visits, decision aids, coaching, facilitation, and audit/feedback.
  • Analyzed semi-structured interviews, field notes, and FRAME-IS data to identify and compare intervention modifications.

Main Results:

  • Identified nine unique, fidelity-consistent modifications across content, evaluation, training, and context.
  • Modifications included alternative risk-classification methods and repackaged materials.
  • Adaptations aligned with local workflows, infrastructure, and organizational context.

Conclusions:

  • Multicomponent interventions can be successfully adapted to diverse clinical settings while preserving core components.
  • Tailoring interventions enhances alignment with local workflows and infrastructure.
  • Findings inform broader de-implementation efforts by demonstrating effective adaptation strategies.