In the intricate world of surgical preparation, patients often find themselves subjected to an array of routinely ordered pre-operative tests, ranging from blood panels to cardiopulmonary evaluations. These assessments—including electrocardiograms, chest x-rays, and comprehensive metabolic panels—have, for decades, formed the cornerstone of perioperative safety protocols. However, emerging evidence now rigorously challenges the necessity of such sweeping testing in healthy individuals undergoing low-risk elective surgeries, suggesting that a substantial proportion of these investigations may be superfluous and offer no tangible benefit to the patient or surgical outcome.
A pioneering study led by researchers at the University of Michigan unveils a paradigm-shifting approach aimed at optimizing pre-operative testing by tailoring strategies to reduce unnecessary examinations without compromising patient safety. This strategy, encapsulated in the “Right-Sizing Testing Before Elective Surgery” program, abbreviated as RITE-Size, represents a carefully calibrated intervention tailored to each hospital’s unique clinical environment. The program’s inception responds to a critical healthcare challenge: the persistence of unwarranted pre-surgical testing that adds healthcare costs, patient inconvenience, and system inefficiencies without improving the clinical course.
The motivation for this research stems from the observation that many routine pre-surgical tests do not inform or alter perioperative management in healthy patients undergoing low-risk procedures such as laparoscopic cholecystectomy, inguinal hernia repair, or breast lumpectomy. Data from three distinct hospitals—two community-based in smaller urban centers and one academically affiliated in a midsize city—revealed an initial baseline wherein an astonishing 68% of ostensibly low-risk patients underwent one or more unnecessary diagnostic tests. This prevalence underscores a systemic inclination toward defensive medicine and entrenched clinical habits that may not align with contemporary evidence-based guidelines.
The RITE-Size initiative embarked on a multipronged, data-informed campaign to foster sustainable change. By first conducting granular analyses into the utilization patterns of eleven commonly performed tests—including cardiac stress evaluations, pulmonary function tests, and coagulation studies—the team gained insights into local clinical decision-making determinants. Following this diagnostic phase, the intervention deployed targeted education, iterative coaching, and continuous feedback loops involving the multidisciplinary perioperative care teams, notably incorporating pre-operative nursing staff whose roles were pivotal to the successful implementation. The strategic inclusion of nursing perspectives acknowledged the underestimated influence these professionals exert in care pathways, as emphasized in an accompanying expert commentary from Stanford University.
Remarkably, the program’s impact was both rapid and durable. Within a mere six months, the frequency of low-value testing declined by approximately 40%, a dramatic improvement corroborated by objective testing data. One of the three hospitals successfully nearly eliminated wasteful pre-operative testing during a portion of the intervention, showcasing the profound influence of tailored educational interventions grounded in institutional context. Such results not only alleviate patient burden but also promise substantial economic benefits by curbing unnecessary healthcare expenditure. These findings hold considerable significance amidst increasing pressures to enhance the value and efficiency of surgical care delivery.
The roots of this research extend back to prior work by the Michigan Program on Value Enhancement (MPrOVE), a collaborative enterprise bridging the U-M Institute for Healthcare Policy and Innovation and Michigan Medicine’s academic medical center. Earlier phases targeted a more limited subset of pre-operative tests and were confined to the U-M Health system. The current study broadens the scope dramatically, encompassing multiple community sites and an expanded array of diagnostic modalities. This scaling reflects both the robustness of the intervention’s framework and the growing recognition of the need to contextualize recommendations within diverse practice environments.
The methodologies employed in RITE-Size epitomize a sophisticated interplay between data analytics, behavioral science, and systems engineering applied to healthcare. By periodically disseminating customized reports, the team empowered clinicians to visualize their test-ordering trends against benchmarks, fostering self-correction and peer-supported accountability. Clinical leaders and pre-operative teams participated in ongoing dialogues to identify barriers and facilitators, allowing the program to dynamically adapt and resonate with frontline providers’ realities. This iterative, feedback-rich approach starkly contrasts with traditional top-down mandates, illustrating how granular, human-centered strategies can drive meaningful quality improvement.
Importantly, the overarching narrative challenges the longstanding dogma of routine pre-operative testing in low-risk surgical candidates. Current guidelines have increasingly cautioned against blanket testing, advocating for a more selective, patient-tailored approach. However, real-world adherence has lagged due to factors such as medico-legal concerns, historical clinical inertia, and fragmented care coordination. This study offers compelling evidence that through nuanced, targeted, and inclusive interventions, entrenched practices can shift substantially toward higher-value care models that prioritize patient safety without waste.
The implications of this work reverberate beyond the three pilot hospitals. Buoyed by demonstrable successes, the RITE-Size program is slated to scale across sixteen additional Michigan hospitals over the ensuing years. This expansion, supported by the Michigan Surgical Quality Collaborative, the Michigan Value Collaborative, and another perioperative quality network called ASPIRE, leverages existing collaborative infrastructures that foster knowledge sharing and comparative benchmarking. Through such concerted collective action, the initiative seeks not only to transform pre-operative testing practices regionally but also to set a blueprint for analogous endeavors nationally and internationally.
Beyond operational impacts, this research resonates within the broader discourse on sustainability and stewardship in healthcare. By effectively addressing overuse, the program exemplifies an ethically and economically responsible approach to resource utilization. Patients spared unnecessary tests avoid potential downstream consequences such as false positives, anxiety, and procedural delays. Additionally, healthcare systems can redirect saved resources toward more clinically impactful initiatives. This alignment of clinical prudence, patient-centeredness, and value-based care encapsulates the evolving ethos of modern healthcare innovation.
As the healthcare community digests and builds upon these findings, the study underscores the vital role of interdisciplinary collaboration in driving change. Surgeons, anesthesiologists, nurses, administrators, and data scientists must coordinate synergistically to dismantle outdated paradigms and implement evidence-based best practices. The RITE-Size model, characterized by its inclusivity and responsiveness to institutional culture, offers a replicable template. By intricately weaving education, data feedback, and stakeholder engagement, it shines a light on pathways to diminish low-value care while enhancing outcomes and patient satisfaction.
In summation, the University of Michigan-led investigation decisively illustrates that right-sizing pre-operative testing for low-risk elective surgeries is not only feasible but yields profound benefits in reducing inefficiencies and optimizing patient care. By identifying and addressing the nuances of institutional behavior, leveraging multidisciplinary engagement, and deploying iterative learning frameworks, RITE-Size charts an innovative course toward smarter surgical preparation. As this initiative scales and informs future quality improvement endeavors, it heralds a new era where precision in testing complements precision in surgery, ultimately fostering a more rational, humane, and effective healthcare system.
Subject of Research: People
Article Title: Right-Sizing Testing Before Elective Surgery for Patients With Low Risk
News Publication Date: 6-Oct-2025
Web References:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.35750
References:
Mott N, Dossett L, et al. Right-Sizing Testing Before Elective Surgery for Patients With Low Risk. JAMA Network Open. 2025.
Keywords: Surgery; Surgical procedures; Diagnostic imaging; Medical tests; Electrocardiography; Breast cancer; Hospitals; Health care delivery; Health care costs; Anesthesiology
Tags: collaborative healthcare strategieselective surgery preparationevidence-based surgical practiceshealthcare cost reduction strategieshospital efficiency in surgical protocolslow-risk surgical procedurespatient safety in surgeryperioperative management improvementpreoperative testing optimizationRITE-Size programtailored preoperative assessmentsunnecessary pre-surgery tests reduction
