For many patients, geting ready to have surgery means getting their blood draw, their heart rhythm checked, or having other tests in the weeks lead up to their operation.

But Not all patients needs all there tests—Specially if the results won’T change how their surgical team treates them or how well they do afterward.

Now, a new study shows how hospitals can focus the use of such tests on the patients who truly need them, while safeli reducing unnecessary testing in others.

The result: Less wasted money and resources for each test, and less wasted time for patients and clinical staff.

The study, Published in Jama surgery By a team from the university of Michigan and Brigham and Women’s Hospital, Tested a Program Designed to Reduce Unnemed Preoperative Tests at UM Health.

It focused on Reducing Four Tests in Low-Risk Patients Having Breast Lumps or Diseased Gallbladders Removed, or hernias fixed, in outpatient operations.

Before the intervention, 37% of such patients had at least one unnecessary test. By the end of the study, that rate dropped to 14%. Overall testing -the percentage of all patients receiving the Four Tests Before Having these operations – Dropped from 51% to 27%.

At the same time, preoperative testing Didn Bollywood for Patients who needed it, based on their health status and surgical risk. Rates of Emergency Department Visits and Hospitalizations styed the same in the weeks after patients had their operations, suggesting that reducing unnecessary testing Didn’t Worsen SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFETY SAFTOMES

The new study shows that during the time when um health reduced unnecessary testing and overall testing, the use of the same tests in similar patients styed the same at dozens of other houses in the state.

Making Change Togeether, and Measuring Its Effect

The Study’s Leader Says it’s not just the drop in unnecessary testing, but the way the team achieved it and measured it that makes the study different.

The intervention focused on educating clinicians on the evidence that they could safly Reduce Testing in Some Patients, and Involving them in how they did So, Says Senior Author and Um Health Surgeon Lheson

“If we truly want to reduce wasteful testing, the Kind that provides no value and won’t change care, we need to help team members undersrstand the rationale, to base out Itive change, and to provide Easy-to-use tools to Support Clinical Decisions, “said dossett. “We’re excited by what we want to achieve at our pre-op-op clinics, and look forward to testing this in hospitals statewide.”

Dossett Co-Lads The Michigan Program on Value Enhancement, or mpove, through which the new study was condited. Mprove teams the clinical quality improvement efforts of um health with the rigorous research methods of the UM Institute for Healthcare Policy and Innovation.

The study involved 1,143 patients with an average age of 58 seen at um health’s three pre-op-op clinics for outpatient surgery sites from june 2022 to the end of August 2023.

Um Health Had High Levels of Pre-Op Testing (Both Necessary and Unnecessary) in a Previous Study of 63 Hospitals Across Michigan Published in 2021, So it was a kee for idy for IT WAS AREA For IT

DURINT The Intervention Period, The Surgeons and Physician Assistants Involved In the Pre-Op Clinics Had Multiple Sessions with the Study Team, And Worked to Build Consensus ARONDS hid not.

In the end, the clinicians were asked to follow a flow chart and grid – Called decision Support Documents – To Determine Whoch Tests A Patient Should have been surgery, Based on his individual characteristics.

The tests in question was selected because years of research and recommendations from National and International Health Care Quality Quality Groups have deemed them Unnecessary for Certain Patients. Blood Tests Called Complete Blood Cell Counts (CBCs), Basic Metabolic Panels (BMPS) and Comprehensive Metabolic Panels (CMPs) were targeted, as were Electrocardiograms.

Each Patient was scored on a Standard Scale Used By Anesthesia Professionals to Rate the Risk of a Patient Suffering a Complication During Anesthesia. Thos on the lowest two Rungs was able to forego all four tests unless a specialist Had specifically Ordered it. But even patients at the higher end of this scale, called the asa physical status, was able to avoid certain tests depending on what other conditions they.

Alexis Antunez, MD, MS, is a UM Medical School Alumna and the Study’s First Author. She was a visiting surgical research residence at Michigan Medicine at the Time of the study and is now at the brigham and women’s department of surgery.

Mprove Program Manager Tony Cuttitta, Mph, Notes That Several Um Medical School Students worked on the study design and data analysis. He also explains that the um team is working to scale up the number of surgical specialtys using the approach and evaluate the impacts.

The effort was so successful that the um team is partnering with 16 other hospitals across Michigan to reepeat the same intervention that spurred the change.

The statewide study is now underway. It Involves Hospitals Taking Part in Collaborative Quality Initiatives and Will Test Whether the Model that Succeded at UM Health is General to Other Care Settings. It will also analyze the financial impact of avoiding unnecessary tests.

In addition to dossett, antunez and cutta, the study’s authors are ruby ​​j. kazemi, ba; Caroline richburg, md; Cecilia Pesavento, MD, MBA; Andrew vastardis, ms; Erin kim, bs; Abigail L. Kappelman, Ma; Devak nanua, ms; Hiba Pediyakkal, ba; Faelan jacobson-davies, ma; Shawna N. Smith, Ph.D.; James Henderson, Ph.D., 10; Valerie gavrila, mph; And Hari Nathan, MD, Ph.D.