"Drop the Pre-op:" Lessons Learned from Applying Population Health Principles


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Low-value care (LVC) is health care that does not improve patient outcomes or for which harms appear to outweigh benefits. The estimated cost to the US healthcare system is $75.7-$101.2 billion. Pre-op testing in low risk surgical patients is an example of low-value care and costs an estimated $18 billion in the US annually. Recognition of the overuse of low-value care led to the establishment of the Choosing Wisely (CW) Initiative by the American Board of Internal Medicine (ABIM) Foundation in 2012. Its goal has been to assist patients and physicians in shared decision making around unnecessary testing and low-value care. Success in lowering LVC, however, has been limited and marginal. In the year 2022, BCHC embarked on an effort to apply population health principles in order to reduce the volume of low-value pre-op testing. This was a PDSA pilot project named “Drop the Pre-op”. Surgeries were performed by General (GEN), ENT, Urology (URO), Podiatry (POD), Gynecology (GYN), Ophthalmology (OPHTH), and Orthopedics (ORTHO). The pre-op laboratory tests included any hematology panels (CBC), any chemistry panels (CMP), urinalysis (UA), chest radiology (CXR), and EKGs. Medical staff was educated on the evidence and cost surrounding wasteful pre-operative testing, and were encouraged to Drop the Pre-op. The initial overall finding was that pre-op lab testing did not significantly improve when comparing PRE and POST education, and with some labs it even worsened. The findings within the BCHC effort to reduce preoperative testing appear discouraging at the outset. It is important to remember, however, that there are still worthwhile lessons to be learned in any quality improvement initiative. Through this process it was discovered that change management and leading change management requires a consistent and formalized process and that the success behind implementation science (or de-implementation in this case) is more difficult than the name implies.



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