Reducing unnecessary preoperative testing in Day Surgery: a Choosing Wisely-based quality improvement study

Area of Science:

• Health Policy
• Quality Improvement
• Anesthesiology

Background:

• Routine preoperative laboratory testing is often overused in low-risk surgery, despite guidelines advising against it for healthy patients.
• This overuse leads to increased healthcare costs, procedural delays, and potential patient harm from unnecessary investigations.
• A need exists to optimize preoperative assessment pathways for efficiency and patient safety.

Purpose of the Study:

• To assess the impact of a redesigned preoperative assessment model, aligned with Choosing Wisely principles, on testing rates, surgical efficiency, and patient outcomes.
• To evaluate the model's effect on laboratory testing, ECGs, chest radiography, surgical delays, and system costs in a day surgery setting.

Main Methods:

• A retrospective pre-post quality improvement study was conducted at a tertiary academic hospital.
• Two cohorts of adult day surgery patients were compared before (June 2022-June 2023) and after (July 2023-July 2024) implementing a new pathway.
• The intervention involved eliminating routine testing for minor cases (ASA I-III) unless clinically indicated by an anesthesiologist.

Main Results:

• Post-intervention, laboratory testing decreased to 2.6%, ECGs to 6.7%, and chest radiography to 0.3%.
• No surgeries were cancelled due to inadequate work-up, and no unplanned postoperative admissions occurred.
• Wait times reduced from weeks to under 7 days, significantly improving system efficiency and reducing costs.

Conclusions:

• A Choosing Wisely-aligned preoperative pathway effectively and safely reduces unnecessary testing in day surgery.
• The implemented model enhances operational efficiency, shortens patient wait times, and lowers healthcare expenditures.
• This scalable approach offers valuable insights for national health policy and Value-Based Health Care initiatives.