Embedded Files
An initiative to reduce unnecessary preoperative testing across Michigan led by MSQC, in partnership with MPrOVE and MVC
Why is preoperative testing overuse a problem?
Why is preoperative testing overuse a problem?
Nationally:
Nationally:
Preoperative testing overuse has been extensively evaluated and found to have negative outcomes such as:
Preoperative testing overuse has been extensively evaluated and found to have negative outcomes such as:
Statewide Across Michigan:
Statewide Across Michigan:
This has led to multiple academic societies recommending against preoperative testing for low-risk procedures. Despite these recommendations, this testing continues to persist.
Efforts to Reduce Preoperative Testing:
Efforts to Reduce Preoperative Testing:
The Michigan Surgical Quality Collaborative (MSQC) has launched a quality improvement project to address overuse of preoperative testing for low-risk surgeries.
The Michigan Surgical Quality Collaborative (MSQC) has launched a quality improvement project to address overuse of preoperative testing for low-risk surgeries.
Click the "Learn More" button and look for "Option C: Appropriate Preoperative Screening for Low-Risk Surgeries Pilot Project."
Click the "Learn More" button and look for "Option C: Appropriate Preoperative Screening for Low-Risk Surgeries Pilot Project."
Strategies to de-implement preoperative testing
Strategies to de-implement preoperative testing
Shown below are examples of specific intervention strategies that target the root of unnecessary preoperative testing. Best practice for deploying these strategies includes establishing a multidisciplinary team to review and adapt these strategies for your specific site. Teams might include surgeons, anesthesiologists, and the preoperative clinic (if applicable).
Shown below are examples of specific intervention strategies that target the root of unnecessary preoperative testing. Best practice for deploying these strategies includes establishing a multidisciplinary team to review and adapt these strategies for your specific site. Teams might include surgeons, anesthesiologists, and the preoperative clinic (if applicable).
Primary Strategies with Resources:
Primary Strategies with Resources:
Guidelines & Provider Resources
Guidelines & Provider Resources
Preoperative testing recommendations for specific low-risk surgeries, complete with a decision aid when evaluating patients.
Education
Education
Preoperative testing has been widely documented as unnecessary for low-risk surgeries. Review the research and commonly mismatched conceptions about this realm of testing.
Secondary Strategies:
Secondary Strategies:
Audit & Feedback
Audit & Feedback
Data and clinical feedback are valuable tools in the improvement process.
Example of how to implement at your site:
Use existing (or create your own) reports that show trends in preoperative testing at your local institution over a certain time period.
Discuss the results with a multidisciplinary team (e.g., surgeons, anesthesia, PCPs, etc.) and identify opportunities to intervene based on the trends you've identified. Generally, it's best to have these conversations at a department or group level first, then have targeted, individual conversations as a follow-up if necessary.
Make a plan to follow up and measure progress at multiple times throughout the project period.
Clinical Decision Support
Clinical Decision Support
Creating enhancements to the EMR that streamlines accurate test ordering can reduce unnecessary tests.
Example of how to implement at your site:
Review current processes that exist for ordering preoperative tests with surgery cases and look specifically at the protocols in place for preoperative testing. You may want to ask your stakeholders:
What does the preoperative test ordering process look like? Who is involved?
Are there tests automatically ordered for each patient? If so, are they necessary?
Can you improve the order set by adding/deleting any specific preoperative tests?
Page updated
Report abuse