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Right-Sizing Testing Before Elective Surgery for Patients With Low Risk.

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A new strategy successfully reduced unnecessary preoperative testing in healthy patients undergoing low-risk surgery. This quality improvement study shows the feasibility of deimplementation across diverse hospital settings.

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Area of Science:

  • Quality Improvement
  • Health Services Research
  • Surgical Oncology

Background:

  • Guidelines advise against routine preoperative testing for healthy patients undergoing low-risk surgery due to lack of benefit and potential harm.
  • Preoperative testing remains common, necessitating effective deimplementation strategies for broad healthcare application.

Purpose of the Study:

  • To assess the feasibility of the Right-Sizing Testing Before Elective Surgery (RITE-Size) strategy.
  • To hypothesize that the RITE-Size strategy would achieve 80% of its implementation milestones on time.

Main Methods:

  • A quality improvement study conducted across three Michigan hospitals from March to August 2024.
  • The RITE-Size strategy involved site visits, coaching, data review, consensus building, and decision support tools.
  • Focus on preoperative bloodwork and cardiopulmonary evaluations for specific low-risk surgeries in healthy adults.

Main Results:

  • All implementation milestones were met on time.
  • The intervention demonstrated high acceptability and appropriateness among stakeholders.
  • Preoperative testing rates decreased significantly from 68.0% to 40.3% (P=.001).

Conclusions:

  • The multifaceted RITE-Size deimplementation strategy is feasible and effective in reducing unnecessary preoperative testing.
  • The findings support the expansion of this strategy in a larger trial and its adoption by hospital systems.
  • Successful implementation was facilitated by cohesive teams and policy integration, despite challenges in education and coordination.