Why are we focusing on just these three surgeries (lumpectomy, hernia repair, laparoscopic cholecystectomy)?

These are surgeries that have been commonly identified as low-risk in the literature and are the same surgeries that the Michigan Value Collaborative (MVC) includes in its preoperative testing reporting; therefore, data is readily available to compare hospitals for a pre and post-intervention period. 

Can this framework be applied outside of these three surgeries?

Absolutely! Refer to the Surgical Risk Estimator for examples of other low-risk surgeries for which preoperative testing may be unnecessary.  As always, clinicians will use their discretion when evaluating patients and recommending testing based on individual factors. 

What if I don't feel comfortable not ordering a standard pre-op test?

These recommendations and guidelines do not replace individual clinician medical decision making and we encourage you to make the decision that is best for each patient. However, we also acknowledge ordering preoperative tests is a practice many providers are used to, so adapting to this framework may take time. These recommendations have been in place by multiple professional societies for years and evidence from the literature shows that these unnecessary preoperative tests cause more harm than good. 

How are MSQC, MVC, and MPrOVE working together?

All three organizations are targeting unnecessary preoperative testing through different data and intervention methods, that complement each other's work. 

• The Michigan Surgical Quality Collaborative (MSQC) leads a variety of quality improvement projects, which this year includes a  project to measure and intervene on low-value preoperative testing. You can find more information here: https://msqc.org/quality-improvement/2023-msqc-quality-initiatives/.

• The Michigan Value Collaborative (MVC) dedicates resources to a preoperative testing value campaign with the aim to reduce unnecessary testing for low-risk surgeries. To support this effort, MVC produces preoperative testing reports for its member hospitals that benchmark performance across its 100+ hospital partners in the state of Michigan. MVC also offers a preoperative testing workgroup series featuring expert speakers and practice sharing. Recently, MVC also integrated preoperative testing as a value metric within its pay-for-performance measure.

• The Michigan Program on Value Enhancement (MPrOVE) focuses on improving quality and demonstrating the value of care at Michigan Medicine, while at the same time catalyzing collaborative research efforts to inform state and national policy decisions. MPrOVE has aided in designing educational materials to de-implement low-value pre-op testing. 

Where can I learn more about de-implementing low-value preoperative testing?

Visit the Background page and explore resources from Choosing Wisely, MVC, and academic articles linked on the page.