Right-Sizing Testing Before Elective Surgery

An initiative to reduce unnecessary preoperative testing before low-risk surgery in Michigan

Why Reduce Preop Testing?

Preoperative testing overuse has been extensively evaluated with evidence of harm for the patient, providers, and health system.

Delayed Medical Treatment

False alarms can cause delays in surgical procedures that result in additional patient injury or discomfort.

Cascade Effect

Unindicated preoperative labs and tests may yield slightly abnormal but clinically insignificant results, leading to even more unnecessary testing and patient stress.

Costly Waste

Lab tests may add to patient financial burdens, and the Institute of Medicine estimates $210B is spent on unnecessary medical testing in the U.S. annually.

No Evidence of Impact on Care

Even when an abnormality is found in a routine preoperative test, this rarely impacts the clinical course of the patient or leads to a substantive change in that patient’s care.

Significant Statewide Variation

Preoperative testing rates prior to low-risk surgeries range from <10% in some hospitals to over 90% in others.

Testing is Common, Despite Risks

Testing before low-risk procedures is common with >50% of patients undergoing at least one test.

How does RITE-Size help?

Three healthcare quality improvement organizations within Michigan have partnered under the umbrella of RITE-Size to collect data on preoperative testing utilization, support inter- and intra-hospital collaboration, and develop resources and strategies to help hospitals de-implement low-value preoperative testing.

Data Analytics & Benchmarking

  • Claims-based data on variation between hospitals
  • Claims-based data on variation within hospitals
  • Statewide analyses of trends by procedure and test
  • Qualitative data on common barriers and motivations

Support & Incentives

  • Peer-to-peer collaboration opportunities
  • Ready-to-use resources and templates
  • De-implementation strategies designed by experts
  • Inclusion in hospital pay-for-performance programs
  • Grant-funded pilot program to support cohorts through de-implementation of low-value testing

“Routine preoperative testing in healthy patients undergoing low-risk surgery does not improve outcomes. It can be wasteful and lead to unnecessary delays. Performing such tests without specific clinical indications can lead to unnecessary consultations and additional tests or invasive procedures, inflating expenditures and causing significant stress for patients. In the worst case, these unnecessary tests and procedures may cause complications and real patient harm.”

Associate Professor of Surgery, Michigan Medicine