{"id":270,"date":"2024-07-24T15:22:21","date_gmt":"2024-07-24T15:22:21","guid":{"rendered":"https:\/\/ritesizetesting.org\/?page_id=270"},"modified":"2024-07-24T15:26:12","modified_gmt":"2024-07-24T15:26:12","slug":"evidence-recommendations","status":"publish","type":"page","link":"https:\/\/ritesizetesting.org\/?page_id=270","title":{"rendered":"Evidence + Recommendations"},"content":{"rendered":"\n<div class=\"wp-block-cover alignfull is-light has-parallax\" style=\"padding-top:var(--wp--preset--spacing--50);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--50);padding-left:var(--wp--preset--spacing--50);min-height:1058px;aspect-ratio:unset;\"><span aria-hidden=\"true\" class=\"wp-block-cover__background has-base-background-color has-background-dim-0 has-background-dim\"><\/span><div class=\"wp-block-cover__image-background wp-image-281 has-parallax\" style=\"background-position:50% 50%;background-image:url(https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research-and-Recommendations-1.png)\"><\/div><div class=\"wp-block-cover__inner-container has-global-padding is-layout-constrained wp-container-core-cover-is-layout-e4fd886c wp-block-cover-is-layout-constrained\">\n<div style=\"height:500px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-custom-color-2-background-color has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-669513ed wp-block-group-is-layout-constrained\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--50);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--50);padding-left:var(--wp--preset--spacing--50)\">\n<div style=\"height:20px;width:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading alignwide has-text-align-center has-custom-color-1-color has-text-color has-link-color has-barlow-font-family has-xx-large-font-size wp-elements-e15e4e053dd5cf2d87536910443adc6f\" style=\"font-style:normal;font-weight:600\">De-Implementation Background Evidence<\/h2>\n\n\n\n<div style=\"height:30px;width:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns alignwide is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column has-custom-color-2-color has-text-color has-link-color has-x-large-font-size wp-elements-039e2d431807470c011c0373fcdb4133 is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:40%\">\n<figure class=\"wp-block-image alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"361\" height=\"351\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png\" alt=\"\" class=\"wp-image-271\" style=\"width:375px;height:auto\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png 361w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image-300x292.png 300w\" sizes=\"auto, (max-width: 361px) 100vw, 361px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:60%\">\n<p class=\"has-custom-color-1-color has-text-color has-link-color has-heading-font-family wp-elements-4242f7c6a2faa1de6a0452145a2c94e8\" style=\"font-size:clamp(1.039rem, 1.039rem + ((1vw - 0.2rem) * 0.935), 1.6rem);line-height:1.2\">Wasteful spending in healthcare has been well documented and researched, with the Institute of Medicine estimating at least <strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-5-color\">$210 billion spent on unnecessary medical testing and care<\/mark><\/strong> in the U.S. each year.<\/p>\n\n\n\n<div style=\"height:24px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color has-heading-font-family wp-elements-5dfa9a4ce0556b2515dc52f87bbe2a7a\" style=\"font-size:clamp(1.039rem, 1.039rem + ((1vw - 0.2rem) * 0.935), 1.6rem);line-height:1.2\">The Washington Alliance&nbsp;estimates that <strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-5-color\">$85.2 million is spent on&nbsp;unnecessary preoperative tests<\/mark> <\/strong>for healthy patients facing low-risk procedures, and many peer-reviewed publications link routine preoperative testing with <strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-5-color\">downstream harm to patients and providers<\/mark><\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-base-background-color has-background has-global-padding is-content-justification-center is-layout-constrained wp-container-core-group-is-layout-d30a6495 wp-block-group-is-layout-constrained\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--50);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--50);padding-left:var(--wp--preset--spacing--50)\">\n<div class=\"wp-block-columns alignwide is-layout-flex wp-container-core-columns-is-layout-549b0c86 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:40%\">\n<figure class=\"wp-block-image size-full is-resized has-custom-border is-style-rounded is-style-rounded--1\"><img loading=\"lazy\" decoding=\"async\" width=\"312\" height=\"382\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/CW-Logo-1.png\" alt=\"\" class=\"has-border-color has-custom-color-1-border-color wp-image-276\" style=\"border-width:8px;width:500px\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/CW-Logo-1.png 312w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/CW-Logo-1-245x300.png 245w\" sizes=\"auto, (max-width: 312px) 100vw, 312px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-container-core-column-is-layout-119bc444 wp-block-column-is-layout-flow\" style=\"flex-basis:60%\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-87beb0d0 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-text-align-left has-heading-font-family wp-container-content-9cfa9a5a\" style=\"font-size:clamp(1.039rem, 1.039rem + ((1vw - 0.2rem) * 0.935), 1.6rem);\"><a href=\"https:\/\/www.choosingwisely.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">Choosing Wisely<\/a> has assembled hundreds of clinical recommendations that aim to <strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">reduce unnecessary testing, are supported by evidence, are free from harm, and are truly necessary.<\/mark> <\/strong>Of these recommendations, Choosing Wisely has a top 12 list, which includes guidelines for preoperative testing in patients scheduled to undergo low- or intermediate-risk non-cardiac surgery.<\/p>\n<\/div>\n<\/div>\n\n\n\n<p style=\"font-size:clamp(16.293px, 1.018rem + ((1vw - 3.2px) * 0.907), 25px);font-style:normal;font-weight:400\"><strong>The Choosing Wisely guidelines are based on clinical recommendations put forth by the following professional medical societies:<\/strong><\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>American Academy of Ophthalmology<\/li>\n\n\n\n<li>American College of Physicians<\/li>\n\n\n\n<li>American College of Radiology<\/li>\n\n\n\n<li>American College of Surgeons <\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>American Society of Anesthesiologists<\/li>\n\n\n\n<li>American Society of Clinical Pathology<\/li>\n\n\n\n<li>American Society of Echocardiography <\/li>\n\n\n\n<li>Society of Thoracic Surgeons <\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-base-2-background-color has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-7cd14b77 wp-block-group-is-layout-constrained\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--60);padding-right:var(--wp--preset--spacing--60);padding-bottom:var(--wp--preset--spacing--60);padding-left:var(--wp--preset--spacing--60)\">\n<div class=\"wp-block-group alignwide is-layout-flow wp-block-group-is-layout-flow\">\n<div style=\"height:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure style=\"margin-right:var(--wp--preset--spacing--60);margin-left:var(--wp--preset--spacing--60)\" class=\"wp-block-video\"><video height=\"1080\" style=\"aspect-ratio: 1920 \/ 1080;\" width=\"1920\" controls poster=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/04\/RITE-Size-Logo-Horizontal_COLOR.png\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/preop-testing-rite-size.mp4\"><\/video><\/figure>\n\n\n\n<div style=\"height:1px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-base-2-color has-contrast-background-color has-text-color has-background has-link-color wp-elements-c9edf0883666196ea8b9d3d48b29fb31 is-horizontal is-content-justification-center is-nowrap is-layout-flex wp-container-core-group-is-layout-8a9ea8f0 wp-block-group-is-layout-flex\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--50);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--50);padding-left:var(--wp--preset--spacing--50)\">\n<div class=\"wp-block-group alignwide has-global-padding is-layout-constrained wp-block-group-is-layout-constrained\">\n<div class=\"wp-block-columns alignwide is-layout-flex wp-container-core-columns-is-layout-d1c656ed wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-stretch is-layout-flow wp-block-column-is-layout-flow\" style=\"padding-right:0;font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);flex-basis:100%\">\n<div style=\"height:2px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color wp-elements-d1ef7408df83202c53ecccfad5db0715\" style=\"font-size:clamp(27.894px, 1.743rem + ((1vw - 3.2px) * 2.094), 48px);\">NATIONAL RECOMMENDATIONS <\/p>\n\n\n\n<p class=\"has-custom-color-4-color has-text-color has-link-color has-heading-font-family wp-elements-2eac12dc35d970cc490964c34434ebef\" style=\"font-size:clamp(21.536px, 1.346rem + ((1vw - 3.2px) * 1.403), 35px);\"><strong>RECOMMENDATIONS BY TEST:<\/strong><\/p>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(0.929rem, 0.929rem + ((1vw - 0.2rem) * 0.785), 1.4rem);\">Multiple societies have recommended against routine preoperative testing (e.g., laboratory studies,&nbsp;chest x-rays, EKGs, cardiac stress tests, etc.) in low-risk patients prior to low-risk procedures.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color wp-elements-5034c3c50d1342b50873b9450a9f820c\" style=\"font-size:clamp(21.536px, 1.346rem + ((1vw - 3.2px) * 1.403), 35px);\">BLOOD WORK<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized has-custom-border is-style-rounded is-style-rounded--2\"><img loading=\"lazy\" decoding=\"async\" width=\"4000\" height=\"2000\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork.png\" alt=\"\" class=\"has-border-color has-custom-color-3-border-color wp-image-287\" style=\"border-width:5px;width:403px;height:auto\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork.png 4000w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork-300x150.png 300w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork-1024x512.png 1024w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork-768x384.png 768w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork-1536x768.png 1536w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Bloodwork-2048x1024.png 2048w\" sizes=\"auto, (max-width: 4000px) 100vw, 4000px\" \/><\/figure>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American Society of Anesthesiologists<\/mark><\/strong> &#8211; Don&#8217;t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) who are undergoing low-risk surgery \u2013 specifically, this applies to complete blood count, basic or comprehensive metabolic panel, or coagulation studies when blood loss (or fluid shifts) are expected to be minimal.<\/p>\n\n\n\n<div style=\"height:1px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div style=\"height:13px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color wp-elements-94c48b7fd2e4527662ad78a01aa1494a\" style=\"font-size:clamp(21.536px, 1.346rem + ((1vw - 3.2px) * 1.403), 35px);\">CHEST X-RAY<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized has-custom-border is-style-rounded is-style-rounded--3\"><img loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"2000\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray.png\" alt=\"\" class=\"has-border-color has-custom-color-3-border-color wp-image-289\" style=\"border-width:5px;width:396px;height:auto\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray.png 2000w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray-300x300.png 300w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray-1024x1024.png 1024w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray-150x150.png 150w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray-768x768.png 768w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Chest-Xray-1536x1536.png 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" \/><\/figure>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American College of Physicians<\/mark><\/strong>&nbsp;&#8211;&nbsp;Don\u2019t obtain routine preoperative chest radiographies in the absence of a clinical suspicion of intrathoracic pathology.<\/p>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American College of Radiology, American College of Surgeons<\/mark><\/strong> &#8211;&nbsp;Avoid preoperative chest radiographies for ambulatory patients with unremarkable history and physical exams.<\/p>\n\n\n\n<div style=\"height:13px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color wp-elements-56bf99c37f8cf90f4922ce2b5bac2e9e\" style=\"font-size:clamp(21.536px, 1.346rem + ((1vw - 3.2px) * 1.403), 35px);\">EKG\/ECG and ECHO TESTS<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized has-custom-border is-style-rounded is-style-rounded--4\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"512\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-1024x512.png\" alt=\"\" class=\"has-border-color has-custom-color-3-border-color wp-image-288\" style=\"border-width:5px;width:402px;height:auto\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-1024x512.png 1024w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-300x150.png 300w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-768x384.png 768w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-1536x768.png 1536w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/ECG-2048x1024.png 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American College of Cardiology<\/mark><\/strong>&nbsp;&#8211;&nbsp;Avoid performing electrocardiography (EKG or ECG) screening as part of preoperative cardiovascular risk assessment in asymptomatic patients scheduled for low-risk non-cardiac surgery.<\/p>\n\n\n\n<p class=\"has-heading-font-family\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American Society of Echocardiography<\/mark>&nbsp;<\/strong>&#8211; Avoid echocardiograms for preoperative\/perioperative assessment of patients with no history or symptoms of heart disease.<\/p>\n\n\n\n<div style=\"height:13px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-custom-color-1-color has-text-color has-link-color wp-elements-80e0d02b85c2a8edbb5ff4a7c211d999\" style=\"font-size:clamp(21.536px, 1.346rem + ((1vw - 3.2px) * 1.403), 35px);\">CARDIAC STRESS TESTS<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized has-custom-border is-style-rounded is-style-rounded--5\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1002\" src=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing-1024x1002.png\" alt=\"\" class=\"has-border-color has-custom-color-3-border-color wp-image-286\" style=\"border-width:5px;width:396px;height:auto\" srcset=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing-1024x1002.png 1024w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing-300x294.png 300w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing-768x751.png 768w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing-1536x1503.png 1536w, https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Cardiac-Stress-Testing.png 2044w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">The Society of Thoracic Surgeons<\/mark><\/strong>&nbsp;&#8211; Patients who have no cardiac history and good functional status do not require preoperative stress testing prior to non-cardiac thoracic surgery.<\/p>\n\n\n\n<p class=\"has-heading-font-family\" style=\"font-size:clamp(14.642px, 0.915rem + ((1vw - 3.2px) * 0.766), 22px);\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-custom-color-4-color\">American Society of Anesthesiologists<\/mark>&nbsp;<\/strong>&#8211; Don\u2019t obtain baseline diagnostic cardiac testing (e.g., echocardiography or cardiac stress testing) in asymptomatic stable patients with known cardiac disease (e.g., CAD, valvular disease) undergoing low or moderate risk non-cardiac surgery.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-custom-color-1-color has-contrast-2-background-color has-text-color has-background has-link-color wp-elements-3651b2802ceac2307bdb01dd03f39e8d has-global-padding is-layout-constrained wp-container-core-group-is-layout-669513ed wp-block-group-is-layout-constrained\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--50);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--50);padding-left:var(--wp--preset--spacing--50)\">\n<div style=\"height:20px;width:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading alignwide has-text-align-left has-custom-color-1-color has-text-color has-link-color has-barlow-font-family has-xx-large-font-size wp-elements-159c2e95a7df09e8e0f19526764bf643\" style=\"font-style:normal;font-weight:600\">Academic Work<\/h2>\n\n\n\n<div style=\"height:30px;width:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns alignwide is-layout-flex wp-container-core-columns-is-layout-9c22b1e3 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li class=\"has-barlow-font-family\">Baskin, A. S., Mansour, A. I., Kawakibi, A. R., Das, P. J., Rios, A. E., Miller, J., &#8230; &amp; Dossett, L. A. (2022).&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0022480421005138?casa_token=u9BHUiPElbUAAAAA:BnPWX6gV4bWTsVLsw_4s_1_3-WKA66i3xVBmZPCEe7vg5fTiAjvz4cp3tENy0l7xv1I7EROfQg\" target=\"_blank\" rel=\"noreferrer noopener\">Perceived Barriers to the De-implementation of Routine Preoperative History &amp; Physicals Preceding Low-risk Ambulatory Procedures: A Qualitative Study of Surgeon Perspectives.<\/a>&nbsp;<em>Journal of Surgical Research<\/em>,&nbsp;<em>270<\/em>, 359-368.<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Berlin, N. L., Yost, M. L., Cheng, B., Henderson, J., Kerr, E., Nathan, H., &amp; Dossett, L. A. (2021).&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2779744\" target=\"_blank\" rel=\"noreferrer noopener\">Patterns and determinants of low-value preoperative testing in Michigan<\/a>.&nbsp;<em>JAMA Internal Medicine<\/em>,&nbsp;<em>181<\/em>(8), 1115-1118.&nbsp;<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Cuttitta, A., Joseph, S. S., Henderson, J., Portney, D. S., Keedy, J. M., Benedict, W. L., &#8230; &amp; Mian, S. I. (2021).&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jamaophthalmology\/article-abstract\/2785554?casa_token=0N3tqeRPWEYAAAAA:Z7qVHlHugbd7wZMukUVFAKtH2XJPE9JhvkzSFtuv3iBknecfTV0RCBY4L9Db4KAcNHbLykUJKws\" target=\"_blank\" rel=\"noreferrer noopener\">Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation<\/a>.&nbsp;<em>JAMA ophthalmology<\/em>,&nbsp;<em>139<\/em>(12), 1309-1312.&nbsp;<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Ganguli I, Simpkin AL, Lupo C, et al.&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/article-abstract\/2752991\" target=\"_blank\" rel=\"noreferrer noopener\">Cascades of Care After Incidental Findings in a US National Survey of Physicians<\/a>.&nbsp;<em>JAMA Network Open.&nbsp;<\/em>2019;2(10):e1913325-e1913325.<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Katz RI, Dexter F, Rosenfeld K, et al.&nbsp;<a href=\"https:\/\/journals.lww.com\/anesthesia-analgesia\/Fulltext\/2011\/01000\/Survey_Study_of_Anesthesiologists__and_Surgeons_.33.aspx?casa_token=1UCj7nK_j9cAAAAA:EWo9V-woDisHaUzSByJqAiWl5rtp-Qc2lJ1pj-k-KrC7Hjl86iXxQmwfUVr6EDE8BXDq8ec_ztT86YPV7NKvEmePepHFvQ\" target=\"_blank\" rel=\"noreferrer noopener\">Survey study of anesthesiologists&#8217; and surgeons&#8217; ordering of unnecessary preoperative laboratory tests.<\/a>&nbsp;<em>Anesthesia and analgesia.&nbsp;<\/em>2011;112(1):207-212.<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Pickering AN, Zhao X, Sileanu FE, et al.&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s11606-022-07561-x\" target=\"_blank\" rel=\"noreferrer noopener\">Prevalence and Cost of Care Cascades Following Low-Value Preoperative Electrocardiogram and Chest Radiograph Within the Veterans Health Administration<\/a>.&nbsp;<em>Journal of general internal medicine.&nbsp;<\/em>2022.<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Salar O, Holley J, Baker B, Ollivere BJ, Moran CG.&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0020138314003921?casa_token=ijCZjlSCWHsAAAAA:hdL5gxwe2ibZUm9T9GtoG34Yno04VqOrXCEwGpCKX4Av8I5ntoTHxCAizSdD3x3jhAaTWiErmw\" target=\"_blank\" rel=\"noreferrer noopener\">Omitting pre-operative coagulation screening tests in hip fracture patients: stopping the financial cascade?<\/a>&nbsp;<em>Injury.&nbsp;<\/em>2014;45(12):1938-1941.<\/li>\n\n\n\n<li class=\"has-barlow-font-family\">Welch JM, Zhuang T, Shapiro LM, Harris AHS, Baker LC, Kamal RN.&nbsp;<a href=\"https:\/\/journals.lww.com\/clinorthop\/Fulltext\/2022\/10000\/Is_Low_value_Testing_Before_Low_risk_Hand_Surgery.3.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Is Low-value Testing Before Low-risk Hand Surgery Associated With Increased Downstream Healthcare Use and Reimbursements?<\/a>&nbsp;A National Claims Database Analysis.&nbsp;<em>Clinical orthopaedics and related research.&nbsp;<\/em>2022.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>De-Implementation Background Evidence Wasteful spending in healthcare has been well documented and researched, with the Institute of Medicine estimating at least $210 billion spent on unnecessary medical testing and care in the U.S. each year. The Washington Alliance&nbsp;estimates that $85.2 million is spent on&nbsp;unnecessary preoperative tests for healthy patients facing low-risk procedures, and many peer-reviewed [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-270","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Evidence + Recommendations - RITE-Size Testing<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ritesizetesting.org\/?page_id=270\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evidence + Recommendations - RITE-Size Testing\" \/>\n<meta property=\"og:description\" content=\"De-Implementation Background Evidence Wasteful spending in healthcare has been well documented and researched, with the Institute of Medicine estimating at least $210 billion spent on unnecessary medical testing and care in the U.S. each year. The Washington Alliance&nbsp;estimates that $85.2 million is spent on&nbsp;unnecessary preoperative tests for healthy patients facing low-risk procedures, and many peer-reviewed [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/ritesizetesting.org\/?page_id=270\" \/>\n<meta property=\"og:site_name\" content=\"RITE-Size Testing\" \/>\n<meta property=\"article:modified_time\" content=\"2024-07-24T15:26:12+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270\",\"url\":\"https:\/\/ritesizetesting.org\/?page_id=270\",\"name\":\"Evidence + Recommendations - RITE-Size Testing\",\"isPartOf\":{\"@id\":\"https:\/\/ritesizetesting.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage\"},\"image\":{\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage\"},\"thumbnailUrl\":\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png\",\"datePublished\":\"2024-07-24T15:22:21+00:00\",\"dateModified\":\"2024-07-24T15:26:12+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/ritesizetesting.org\/?page_id=270\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage\",\"url\":\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png\",\"contentUrl\":\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png\",\"width\":361,\"height\":351},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/ritesizetesting.org\/?page_id=270#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/ritesizetesting.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Evidence + Recommendations\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/ritesizetesting.org\/#website\",\"url\":\"https:\/\/ritesizetesting.org\/\",\"name\":\"RITE-Size Testing\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/ritesizetesting.org\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/ritesizetesting.org\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/ritesizetesting.org\/#organization\",\"name\":\"RITE-Size Testing\",\"url\":\"https:\/\/ritesizetesting.org\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/ritesizetesting.org\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/04\/RITE-Size-Logo-Square_NAVY-WHITE.png\",\"contentUrl\":\"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/04\/RITE-Size-Logo-Square_NAVY-WHITE.png\",\"width\":1000,\"height\":1000,\"caption\":\"RITE-Size Testing\"},\"image\":{\"@id\":\"https:\/\/ritesizetesting.org\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Evidence + Recommendations - RITE-Size Testing","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/ritesizetesting.org\/?page_id=270","og_locale":"en_US","og_type":"article","og_title":"Evidence + Recommendations - RITE-Size Testing","og_description":"De-Implementation Background Evidence Wasteful spending in healthcare has been well documented and researched, with the Institute of Medicine estimating at least $210 billion spent on unnecessary medical testing and care in the U.S. each year. The Washington Alliance&nbsp;estimates that $85.2 million is spent on&nbsp;unnecessary preoperative tests for healthy patients facing low-risk procedures, and many peer-reviewed [&hellip;]","og_url":"https:\/\/ritesizetesting.org\/?page_id=270","og_site_name":"RITE-Size Testing","article_modified_time":"2024-07-24T15:26:12+00:00","og_image":[{"url":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/ritesizetesting.org\/?page_id=270","url":"https:\/\/ritesizetesting.org\/?page_id=270","name":"Evidence + Recommendations - RITE-Size Testing","isPartOf":{"@id":"https:\/\/ritesizetesting.org\/#website"},"primaryImageOfPage":{"@id":"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage"},"image":{"@id":"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage"},"thumbnailUrl":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png","datePublished":"2024-07-24T15:22:21+00:00","dateModified":"2024-07-24T15:26:12+00:00","breadcrumb":{"@id":"https:\/\/ritesizetesting.org\/?page_id=270#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/ritesizetesting.org\/?page_id=270"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/ritesizetesting.org\/?page_id=270#primaryimage","url":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png","contentUrl":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/07\/Research_Rec-Image.png","width":361,"height":351},{"@type":"BreadcrumbList","@id":"https:\/\/ritesizetesting.org\/?page_id=270#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/ritesizetesting.org\/"},{"@type":"ListItem","position":2,"name":"Evidence + Recommendations"}]},{"@type":"WebSite","@id":"https:\/\/ritesizetesting.org\/#website","url":"https:\/\/ritesizetesting.org\/","name":"RITE-Size Testing","description":"","publisher":{"@id":"https:\/\/ritesizetesting.org\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/ritesizetesting.org\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/ritesizetesting.org\/#organization","name":"RITE-Size Testing","url":"https:\/\/ritesizetesting.org\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/ritesizetesting.org\/#\/schema\/logo\/image\/","url":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/04\/RITE-Size-Logo-Square_NAVY-WHITE.png","contentUrl":"https:\/\/ritesizetesting.org\/wp-content\/uploads\/2024\/04\/RITE-Size-Logo-Square_NAVY-WHITE.png","width":1000,"height":1000,"caption":"RITE-Size Testing"},"image":{"@id":"https:\/\/ritesizetesting.org\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/pages\/270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=270"}],"version-history":[{"count":19,"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/pages\/270\/revisions"}],"predecessor-version":[{"id":389,"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=\/wp\/v2\/pages\/270\/revisions\/389"}],"wp:attachment":[{"href":"https:\/\/ritesizetesting.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}