Before surgery, many patients go through a series of tests, such as blood work and heart rhythm checks. However, not all these tests are necessary. In many cases, they do not change the treatment plan or improve the outcome. Reducing unnecessary tests could save time, money, and resources for both hospitals and patients.
A new study from the University of Michigan (U-M) and Brigham and Women’s Hospital shows how hospitals can safely reduce unnecessary pre-surgery tests.
The research focused on patients having low-risk surgeries, such as removing breast lumps, treating gallbladder disease, or fixing hernias. These operations are done in outpatient settings, meaning patients go home the same day.
How the Study Worked
Before the study, 37% of patients undergoing these surgeries had at least one test that was not needed. By the end of the study, that number dropped to 14%. Overall, testing rates for these patients decreased from 51% to 27%.
Importantly, patients who actually needed tests based on their health conditions continued to receive them. The study also found that reducing unnecessary testing did not lead to more emergency visits or hospital stays after surgery. This means that skipping unnecessary tests did not harm patients or increase risks.
The researchers also found that while U-M Health successfully reduced testing, other hospitals in Michigan continued to perform the same number of tests. This suggests that there is still a widespread habit of ordering unnecessary tests in many hospitals.
What Made This Study Different?
The research team did more than just cut back on testing—they involved medical staff in the process. Instead of simply telling doctors and nurses to stop ordering tests, they provided education on why some tests are unnecessary. They also created easy-to-use guidelines to help medical teams decide which tests were needed.
Dr. Lesly Dossett, the senior author of the study and a surgeon at U-M Health, explained that reducing wasteful testing requires more than just policy changes.
“We need to help team members understand the reasons behind the change and provide them with simple tools to guide their decisions,” she said. “We’re excited about what we achieved and hope to expand this effort to hospitals across the state.”
The study was conducted through the Michigan Program on Value Enhancement (MPrOVE), a program that combines medical research with efforts to improve hospital efficiency.
How the Change Was Made
The study followed 1,143 patients, with an average age of 58, who visited U-M Health’s pre-surgery clinics between June 2022 and August 2023. Previously, U-M Health had high levels of both necessary and unnecessary testing, making it an ideal place to test this new approach.
During the study, surgeons and physician assistants worked together to decide which tests were truly needed. They used simple decision charts to guide them. The four main tests targeted in this study were:
- Complete blood cell counts (CBCs)
- Basic metabolic panels (BMPs)
- Comprehensive metabolic panels (CMPs)
- Electrocardiograms (EKGs)
For patients with low health risks, all four tests were skipped unless a specialist requested them. Even for higher-risk patients, some tests were avoided based on their medical history.
What’s Next?
The success of this study has led to an even bigger project. U-M Health is now working with 16 other hospitals in Michigan to expand the effort. This larger study will examine whether the same strategy can work in different hospital settings and whether it provides financial benefits.
Several researchers, medical students, and healthcare professionals contributed to the study. Lead author Dr. Alexis Antunez was a visiting researcher at Michigan Medicine during the study and is now working at Brigham and Women’s Hospital.
Review and Analysis
This study highlights a simple but effective way to improve healthcare. Unnecessary pre-surgery testing is a common problem that wastes resources and adds extra stress for patients. By educating medical staff and using clear guidelines, hospitals can reduce these tests without harming patient safety.
The results show a major drop in unnecessary testing without any negative impact on health outcomes. The study also demonstrates the importance of involving medical professionals in decision-making rather than simply enforcing new policies.
However, the research was limited to outpatient surgeries in one hospital system. While it is promising, the ongoing statewide study will provide more insights into whether this approach can work across different hospitals.
If successful, this initiative could lead to changes in how hospitals across the country approach pre-surgery testing. It could also encourage more hospitals to reconsider which tests they order for patients and ensure that every test truly benefits the person receiving it.
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The research findings can be found in JAMA Surgery.
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