Tailoring & teamwork help hospitals reduce wasteful pre-surgery testing

Every day, patients with an upcoming operation roll up their sleeves for blood tests or get heart and lung tests and scans.  

But in many cases, they don’t actually need to have these tests, because the results won’t change how their surgical team cares for them.  

Reducing unneeded pre-operative testing could save time, hassle and money. But hospitals have struggled to reduce wasteful tests while keeping valuable ones, because of a variety of factors.  

Now, a new study led by a University of Michigan team shows a way to achieve sustained success in reducing unneeded pre-op testing. The findings have already spurred an expansion of the program, called Right-Sizing Testing Before Elective Surgery, or RITE-Size for short.

The three hospitals in the study started out with unneeded testing being done in 68% of healthy patients having three types of elective surgery, to remove their gallbladder, fix a hernia or remove a breast lump.  

By the end of six months, thanks to a tailored approach to educating and supporting teams, about 40% of such patients had the tests. One of the hospitals achieved a near-zero wasteful testing rate for a while.  

“Our results show the importance of understanding what factors influence testing decisions at each hospital, and tailoring a multidimensional intervention to that environment,” says Lesly Dossett, M.D., M.P.H., senior author of the paper and a surgeon and health care researcher at U-M Health.  

Dossett co-directs the Michigan Program on Value Enhancement, or MPrOVE, which has sponsored efforts to reduce low-value pre-surgical testing for several years and developed RITE-Size. The lead author of the new paper is Nicole Mott, M.D., MSCR, a National Clinician Scholar at U-M supported by the Veterans Administration and a general surgery resident at the University of Colorado.  

Earlier this year, the MPrOVE team published results from the initial phase, carried out at U-M Health’s own hospitals and clinics and focused on four tests.  

The new paper, published in JAMA Network Open, goes beyond that one, by focusing on 11 tests and documenting the impacts of a multi-step effort to reduce testing by creating a tailored program for each hospital.  

The findings involve data from patients who had laparoscopic cholecystectomies, inguinal hernia repairs, and breast lumpectomies at one of the three hospitals over six months of 2024.  

The hospitals were two community hospitals in smaller cities and an academically affiliated hospital in a midsize city. They were purposively selected from the dozens of Michigan hospitals taking part in the Michigan Value Collaborative and the Michigan Surgical Quality Collaborative.  

The tests that were targeted for reduction in healthy patients were electrocardiography, transthoracic echocardiography, cardiac stress tests, chest X-rays, urinalysis, complete blood cell count, basic metabolic panel, comprehensive metabolic panel, coagulation studies, and pulmonary function tests, including blood gas analysis and spirometry.

The RITE-Size team started by evaluating use of those tests in elective surgery patients undergoing low-risk procedures, and meetings with leaders of the pre-operative and surgical teams. They then offered education, coaching and supportive materials to the entire team involved in ordering and conducting pre-op testing. This included regular data reports to help teams understand how they were doing over time.

The new paper is accompanied by an invited commentary, which notes that the inclusion of pre-operative nurses in the RITE-Size implementation model is crucial. “Too often implementation and quality improvement studies fail to recognize both the value and power held by nurses as part of the health system. This study is a great example of how understanding and including this factor led to success of their pilot intervention,” writes Clifford Sheckter, M.D., M.S. of Stanford University.

The success of the effort has led to the expansion of RITE-Size to 16 more Michigan hospitals over the course of 2025 and 2026. In addition to MVC and MSQC, a third collaborative quality initiative, called ASPIRE and part of the Multicenter Perioperative Outcomes Group, is now involved.

MPrOVE is a joint program of the U-M Institute for Healthcare Policy and Innovation and Michigan Medicine, the U-M academic medical center that includes U-M Health hospitals and clinics.

The study was funded by a grant from the federal Agency for Healthcare Research and Quality (5R01HS029306-02). The collaborative quality initiatives are supported by Blue Cross Blue Shield of Michigan.

In addition to Mott and Dossett, the study’s authors are Dana Greene Jr, MPH; Erin Kim, BS; Valerie Mefford, MPH; Anthony Cuttitta, MPH; Faelan Jacobson-Davies, MA; Shawna N. Smith, PhD; Eve A. Kerr, MD, MPH; Anthony L. Edelman, MD, MBA; Michael Mathis, MD, MPH; Michael Englesbe, MD; and Hari Nathan, MD, PhD.

Citation: Right-Sizing Testing Before Elective Surgery for Patients With Low Risk, JAMA Network Open, doi:10.1001/jamanetworkopen.2025.35750