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

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.