Study Shows Hospitals Can Safely Cut Unnecessary Pre-Surgery Tests
Reducing wasteful pre-op testing doesn’t just save money, it streamlines lab operations and strengthens value-based care. Here’s how Michigan hospitals achieved lasting change.
For laboratory leaders, efforts to reduce unnecessary pre-operative testing strike at the intersection of clinical quality, efficiency, and resource management. A new University of Michigan–led study offers evidence that hospitals can safely scale back low-value pre-surgical tests without compromising patient outcomes. Laboratories play a crucial role in making that happen. By streamlining test utilization and aligning ordering practices with true clinical need, labs can help health systems cut costs, reduce workload, and focus resources on the diagnostics that truly guide surgical care.
The initiative, dubbed “Right-Sizing Testing Before Elective Surgery (RITE-Size),” demonstrated that hospitals can substantially cut back on unnecessary tests for healthy patients undergoing low-risk surgeries.
“Our results show the importance of understanding what factors influence testing decisions at each hospital, and tailoring a multidimensional intervention to that environment,” said Lesly Dossett, MD, MPH, senior author of the paper and a surgeon and healthcare researcher at U-M Health.
The study, published in JAMA Network Open, tracked outcomes at three Michigan hospitals, two community hospitals and one academically affiliated facility, participating in statewide collaborative quality initiatives. Before RITE-Size was implemented, 68% of healthy patients having gallbladder removals, hernia repairs, or breast lumpectomies received at least one unnecessary pre-op test. Six months later, that number had dropped to about 40%, with one hospital achieving a near-zero rate of wasteful testing.
Tailored Interventions Drive Measurable Change
The RITE-Size program was developed through the Michigan Program on Value Enhancement (MPrOVE), a joint initiative of Michigan Medicine and the U-M Institute for Healthcare Policy and Innovation. It builds on earlier work by MPrOVE to identify and eliminate low-value testing in elective surgery settings.
Lead author Nicole Mott, MD, MSCR, a National Clinician Scholar at U-M and general surgery resident at the University of Colorado, said the effort’s success came from a “tailored, team-based approach.” Hospitals began by assessing which tests were routinely ordered for low-risk surgeries, then convened meetings with surgical and pre-op leaders to understand local habits and barriers.
The RITE-Size team provided targeted education, coaching, and easy-to-use support materials. Regular data reports helped teams track their progress and maintain engagement.
Tests targeted for reduction included electrocardiograms, echocardiograms, cardiac stress tests, chest X-rays, urinalysis, and common blood panels. These procedures don’t often influence surgical outcomes for otherwise healthy patients.
An invited commentary accompanying the paper highlighted a key factor in RITE-Size’s success: inclusion of pre-operative nurses. “Too often implementation and quality improvement studies fail to recognize both the value and power held by nurses as part of the health system,” said Clifford Sheckter, MD, MS, of Stanford University. “This study is a great example of how understanding and including this factor led to success of their pilot intervention.”
Expansion Signals a Shift Toward Smarter Utilization
According to Dossett, the findings underscore that waste reduction isn’t simply a matter of enforcing new rules but requires understanding each hospital’s culture and workflow.
Lesly Dossett, MD, MPH, senior author of the paper and a surgeon and healthcare researcher at U-M Health noted, “Tailoring interventions to the local environment and engaging all members of the care team—including nurses and front-line staff—is essential. (Photo credit: U-M Health)
The success of the pilot has already led to an expansion: RITE-Size will roll out to 16 additional Michigan hospitals in 2025 and 2026. In addition to the Michigan Value Collaborative (MVC) and the Michigan Surgical Quality Collaborative (MSQC), a third statewide effort—ASPIRE, part of the Multicenter Perioperative Outcomes Group — has joined the project.
The study was funded by the Agency for Healthcare Research and Quality (Grant 5R01HS029306-02). The collaborative quality initiatives involved are supported by Blue Cross Blue Shield of Michigan.
As hospitals nationwide continue to face pressure to deliver high-quality, efficient care, the Michigan team’s results provide a roadmap for reducing wasteful practices. “We’ve shown it’s possible to right-size testing—and to keep it that way,” Dossett said.
—Janette Wider
