Choosing Wisely

What is Choosing Wisely?

Choosing Wisely is a campaign designed to promote conversations between providers and patients. Helping both parties choose care that is supported by evidence, free from harm, and truly necessary.

The American Board of Internal Medicine (ABIM), initiated Choosing Wisely in early 2012. Two years later, the campaign expanded to Canada. Since then, a number of medical specialty societies and community partners are participating in the campaign.

Where have we implemented Choosing Wisely?

Vancouver Coastal Health and Providence Health Care are participating in Choosing Wisely Canada (CWC). The first initiative being rolled out across both organizations is Choosing Wisely: Medical Imaging.  Since 2016, CW initiatives at VCH and PHC have expanded to Transfusion Medicine and Medical Microbiology.

Why have we implemented Choosing Wisely?

The culture of “more is always better” needs to be changed, it is essential to decrease the overuse in hospitals (Dr. Wendy Levinson, 2014). We want to create healthy relationships between physicians and patients. Decreasing the amount of unnecessary testing for patients will in turn increase the trust between both parties. 

Are you an early adopter?

Are you and your colleagues implementing an initiative under Choosing Wisely Canada? If so, we’d love to hear about it and let others know about it. Please email a few details to Vivian Chan.

  • What is the name of your initiative?
  • Which of CWCs partner organization does your work fall under?
  • Where is it being implemented?
  • Who’s involved? What sites? What physicians?
  • Where are you in the process and when will it be launched?
  • How do you plan to measure the outcomes?

What has Choosing Wisely Accomplished?

 

Imaging for uncomplicated back pain (CT, MRI, X-Ray) will not speed up recovery but it can expose you to unnecessary risks.

  • Imaging orders for uncomplicated back pain at SPH ED have decreased, from 22%-17%.

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When red flags are non-existent there is no need for advanced imaging in patients with significant OA.

  • 21% of MI referrals were avoided in the pilot period at VA
  • MRI for major joints of outpatients at VA average decrease of 0.5%.

 

Both the emergency department and family practitioners order CT for uncomplicated headaches under a new process.

  • Imaging of uncomplicated headaches at LGH ED decrease by 0.7%
  • Head CT’s for outpatients at LGH decrease of 1.6%

 

Why use two when one will do?

  • Don’t transfuse more than one red cell unit at a time when transfusion is required in stable, non-bleeding patients.
  • Single red blood cell transfusion has increased from 56% to 64% at VGH by changing order sets

 

Repetitive, “routine” blood tests are associated with hospital acquired and/or worsening anemia, which is in turn associated with an increased risk of dying.

  • 10% reduction of blood work collections from inpatient acute wards at SPH within 3 months of a policy implementation

 


Check out this video if you aren’t already convinced to choose wisely!