Prior to surgery, most Michigan patients will undergo a series of tests, such as blood draws, urinalysis, chest x-rays, or electrocardiograms (ECGs/EKGs). Many of these tests are unnecessary for healthy patients undergoing low-risk procedures, such as groin hernia repair or cholecystectomy. Routine preoperative testing is widely considered a low-value service, and yet a majority of hospitals continue to order these tests.
Last week the Michigan Value Collaborative (MVC) helped to increase awareness about low-value preoperative testing during its first-ever Preoperative Testing Awareness Week. MVC distributed press releases, published a daily cadence of social media content on Twitter and LinkedIn, and launched a new video (shown above) about preoperative testing – all in service of inspiring collaboration in this area.
MVC first focused on preoperative testing in 2020, when the Coordinating Center selected it as a priority area for its Value Coalition Campaigns. Since then, MVC has taken steps to reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve the equity of care delivery in Michigan. Throughout Preoperative Testing Week, the Coordinating Center’s goals were to describe the potential harm of unnecessary testing, showcase the variability in testing practices across the collaborative, and connect members with MVC resources that could help.
MVC primarily supports members via two key strategies. One is data analysis and reporting. MVC analysts utilize administrative claims data to calculate testing rates in the preoperative period, and then share these results with members as reports or as unblinded data at collaborative-wide meetings. More recently, MVC partnered with the Michigan Surgical Quality Collaborative (MSQC) to distribute these reports more widely, which enables both clinical and quality personnel to identify patterns, explore new strategies, and work together to reduce preoperative testing at each hospital.
These reports are an invaluable resource in benchmarking the extent of the issue statewide since MVC data can show members how their rates compare to other Michigan hospitals. By focusing on a homogeneous cohort of healthy patients undergoing common, low-risk surgical procedures, MVC benchmarks can help all hospitals understand where they have an opportunity to improve, regardless of facility size, resources, or patient population.
MVC data reveals large variability between hospitals—so much so that even high-performing hospitals have room to safely reduce testing rates. Across the collaborative, preoperative testing rates among young, healthy patients range from 10% to 97% in MVC hospitals. Even within hospitals, there is usually variation, with certain surgeries driving the overall rate.
The other key strategy MVC uses to support members is engagement events, which help facilitate collaboration and resource sharing among peer hospitals and physician organizations. The MVC team supports its member base of more than 100 hospitals and 40 physician organizations through events like stakeholder meetings and workgroups, where clinicians and quality improvement staff can discuss solutions to common challenges. Last week, MVC hosted a special, one-time workgroup on preoperative testing as part of its “Health in Action” workgroup series. The session featured guest presenter Dr. Michael Danic, DO, for a presentation titled, “Safe, Evidence-Based Reductions in Preoperative Testing: Why is it so hard to change?” Dr. Danic is a board-certified anesthesiologist at Ascension Genesys who has served in several leadership positions for quality and safety initiatives. A recording of the full workgroup is available here.
At the conclusion of the week, the MVC team helped its stakeholders connect to educational materials, data, specialists, and successful peers in this space. The Coordinating Center urges its members to take steps to understand their role in unnecessary preoperative testing and improve the patient experience.
The Coordinating Center is eager to continue this momentum in pursuit of a variety of goals for 2022 and beyond. If your hospital or physician organization would like support with reducing preoperative testing rates or has a success story that could help others, please reach out directly to MVC at michiganvaluecollaborative@gmail.com.
