Opening Remarks: 

• Dr. Wendy Levinson, Chair, Choosing Wisely Canada
• Dr. Alika Lafontaine, President, Canadian Medical Association

How does overuse of tests and treatments contribute to health inequities? Our expert panel will discuss systemic inequities as well as the role of reducing overuse in improving greater access to health services for all.

• Dr. Sanjeev Sockalingam, Vice President of Education, CAMH
• Dr. Shail Rawal, General Internist, University Health Network
• Dr. Alika Lafontaine, President, Canadian Medical Association 

Learning Objectives:

• Examine the intersection between health equity and overuse issues in practice 
• Describe current gaps and barriers in addressing health equity 
• Identify examples of advancing effective health equity in practice  

Learn how to tackle overuse in your practice through hot topic sessions and abstract presentations featuring innovative approaches from across the country.

Science Communication in the Misinformation Era

With today’s rapid news cycle and misinformation spreading online, communicating evidence-based information can be challenging. Dr. Samir Gupta will share insights on the current media landscape and propose strategies and approaches for addressing mis/disinformation and communicating science clearly and effectively with patients and the public.

Dr. Samir Gupta, Respirologist and Clinician-Scientist, Unity Health Toronto

Learning Objectives: 

• Recognize the challenges of communicating evidence-based information 
• Describe how to strengthen the use of scientific evidence and health literacy to help debunk misinformation 
• Identify approaches to effectively communicate medical information clearly and effectively with the public

Choosing Wisely in Long-Term Care

The overuse of tests and treatments in older adults can have significant implications for quality of care and patient safety. Dr. Sid Feldman, Dr. Elliot Lass, and Dr. Andrea Moser will share relevant implementation efforts and tools to support staff caring for LTC residents and ensure limited resources are used wisely. 

Dr. Andrea Moser, Family Physician, Baycrest
Dr. Elliot Lass, Family Physician
Dr. Sid Feldman, Family Physician, Baycrest 

Learning Objectives: 

• Describe Choosing Wisely Canada recommendations for LTC residents and the impact of COVID-19 on implementation 
• Examine approaches to avoid unnecessary hospital transfers and encourage goals of care conversations in LTC 
• Recognize approaches to avoiding potentially harmful medications for LTC residents

Abstract Session: Reducing Overuse and Our Carbon Footprint

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature initiatives tackling waste, harm, and our carbon footprint.

Engaging Family Medicine Residents to Reduce Pmdi Prescriptions in a Family Health Team
Nicole Nakatsu, Pharmacist, Kingston Health Sciences Centre

Building Health System Sustainability and Resilience Through the Co-benefits of Reducing Low-Value Care and Reducing the Environmental Impacts of Care: Developing an International Research & Implementation Agenda
Dr. Gillian Parker, Research Lead, Centre for Sustainable Health Systems

Patient, Hospital, and Environmental Costs of Unnecessary Bloodwork: Capturing the Triple Bottom Line of Inappropriate Care
Dr. Annie Lalande, Vancouver Coastal Health

Environmental Stewardship: An Implementation Guide for Boards, Management, and Clinical Staff
Neha Mathur and Emma Ko, Michael G. DeGroote School of Medicine

Learning Objectives: 

• Recognize the important role clinicians play in leading change in the climate crisis 
• Describe practical examples of environmentally sustainable initiatives to reduce overuse in practice
• Discuss tools and resources to support clinicians in implementing environmentally sustainable practice

Shared Decision-Making in Primary Care

Dr. Janet Reynolds and Dr. Guylène Thériault will share the latest strategies and approaches to shared decision-making in primary care using examples from a recent implementation effort to embed serious illness conversations in practice.

Dr. Janet Reynolds, Primary Care Co-Lead, Choosing Wisely Canada
Dr. Guylène Thériault, Primary Care Co-Lead, Choosing Wisely Canada

Learning Objectives: 

• Explain the importance of involving patients in decision-making in a context of overuse
• Identify potential barriers to effective communication about the risk of overdiagnosis/overuse
• Outline shared decision-making support tools to support conversations about unnecessary tests and treatments.

Mobilizing the Next Generation to Choose Wisely

Dr. William Silverstein will facilitate this session, where medical student leaders will showcase innovative approaches and strategies to engage learners in resource stewardship during training.

Dr. William Silverstein, General Internist, Sunnybrook Health Sciences Centre, STARS Lead

Learning Objectives:

• Recognize the importance of resource stewardship competencies in medical education
• Describe how to leverage medical student leadership in implementing Choosing Wisely initiatives
• Show examples of successful medical student leadership from across the country to advance resource stewardship initiatives

Learn how to tackle overuse in your practice through hot topic sessions and abstract presentations featuring innovative approaches from across the country.

A Primer on Using Data to Demonstrate Improvement  

Teams implementing Choosing Wisely improvement projects need to determine whether they have successfully reduced unnecessary tests and treatments. Knowledge of fundamental principles in managing and analyzing data, in particular time-series techniques such as run and control charts commonly used in quality improvement, allows teams to add a rigorous approach to evaluating their Choosing Wisely improvement projects.

Dr. Brian Wong, General Internist, Sunnybrook Health Sciences and Director of the Centre for Quality and Patient Safety

Learning Objectives: 

• Differentiate between different types of data used for quality improvement
• Describe the advantages of using run and control charts for Choosing Wisely improvement projects
• Interpret run and control charts to determine whether improvement has occurred

Policy as a Tool for Reducing Overuse

Many drivers of overuse are “baked in” to the system and beyond the control of individual clinician decision-making that require top-down interventions. Tai Huynh, Heather Logan, and James Silvius share insights on how, if done wisely, policy change can be a powerful force for massive reductions in overuse and improving health system sustainability.

Susan Fitzpatrick, Head, Canadian Drug Agency Transition Office
Tai Huynh, Campaign Director, Choosing Wisely Canada
Heather Logan, Vice President, Strategic Relationships, CADTH
Dr. James Silvius, Executive Director, Canadian Medication Appropriateness and Deprescribing Network

Moderated by: Nicole Williams, Director, Negotiations Branch, Ontario Ministry of Health

Learning Objectives: 

• Describe how changes to policy, regulations, and system design can support reduction efforts
• Illustrate the role of clinicians and health administrators in advocating for policy change
• Discuss the limits of policy levers and how to avoid unintended consequences

Choosing Wisely in Pediatrics

This session will provide practical insights and approaches to integrating Choosing Wisely and resource stewardship in settings caring for children.

Dr. Olivia Ostrow, Staff Physician, Emergency Medicine, SickKids Hospital
Dr. Jeremy Friedman, Paediatrician-in-Chief, Department of Paediatrics, SickKids Hospital
Lauren Whitney, Project Manager, SickKids Hospital

Learning Objectives:

• Describe practice changes to reduce the overuse of tests and treatments in pediatric populations
• Describe effective approaches to integrating Choosing Wisely implementation efforts in pediatric settings
• Identify tools and opportunities to support clinicians in pediatric resource stewardship efforts

Behavioural Science for Choosing Blood Wisely

An introduction to behavioural economics and how these methods might be applied to improve decision-making in blood transfusion. Dr. Raza Sheharyar will briefly overview GADGET, an on-going implementation project powered by the GEMINI data platform.

Dr. Raza Sheharyar, General Internist, Sunnybrook Health Sciences Centre

Learning Objectives:

• Define and give examples of behavioural economics in healthcare
• Describe nudge theory and scenarios for applying it
• Recognize the scope of the GADGET project and the GEMINI platform

Abstracts on Appropriate Prescribing

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature initiatives promoting appropriate prescribing practices.

Sleepwell: Transitioning From Sedatives to Behavioural Interventions for Insomnia in Primary Care
Dr. David Gardner, Department of Psychiatry, Dalhousie University

Improving Medication Appropriateness and Quality of Care for Complex Older Adults in Primary Care
Dr. Alexander Singer, Associate Professor, Department of Family Medicine, University of Manitoba

Overtreatment and Deprescribing of Antihyperglycemics Among Long-Term Care Residents in British Columbia
Dr. Wade Thompson, Assistant Professor, University of British Columbia

Learning Objectives:

• Describe efforts to reduce inappropriate prescribing in practice 
• Illustrate successful examples of implementation efforts to decrease inappropriate prescribing 
• Identify tools and resources that can support clinicians in deprescribing practices

Learn how to tackle overuse in your practice through hot topic sessions and abstract presentations featuring innovative approaches from across the country.  

Deprescribing Wisely

Deprescribing is an effective strategy for health care providers to help safely cut back or stop medications that are no longer useful or may cause harm. Wade Thompson and Lisa McCarthy share deprescribing strategies and how to apply these approaches to your Choosing Wisely efforts.

Dr. Wade Thompson, Assistant Professor, University of British Columbia
Dr. Lisa McCarthy, Clinician Scientist, Trillium Health Partners, University of Toronto

Learning Objectives:

• Describe effective deprescribing strategies within Choosing Wisely initiatives 
• Develop a systemic approach allowing the implementation of deprescribing practices
• Identify tools and resources that can support clinicians in deprescribing practices

Preventing Burnout

Although the goal of QI is to make improvements to healthcare delivery it often results in increased workload and change fatigue amongst those required to adopt the QI intervention. Dr. Chris Hayes shares insights and effective approaches to ensuring QI will improve not worsen Joy in Work.

Dr. Chris Hayes, Chief Health Information Officer, Trillium Health Partners

Learning Objectives:

• Recognize the contributors to clinician burnout and burnout from change.
• Describe effective strategies and approaches to addressing burnout in practice.
• Identify tools and resources that can support clinicians in preventing workforce burnout.

 Abstracts on Low-Value Lab Testing

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature abstracts on reducing low-value lab testing.

Optimizing the Submission of Surgical Specimens to the Anatomic Pathology Laboratory
Dr. Anne Bergeron, Institut national d’excellence en santé et en services sociaux (INESSS)

Introducing an AST Reflex Algorithm to Reduce Unnecessary Ast Testing
Vidushi Swarup, Clinical Research Coordinator, St. Michael’s Hospital

Factors of a Physician Quality Improvement Leadership Coalition That Influence Physician Behaviour
Dr. Pamela Mathura, University of Alberta – Department of Medicine and Alberta health Services

Optimization of 25 OH Vitamin D Testing in Renal Patients
Dr. Curtis Oleschuk, Clinical Biochemist, Assistant Professor, Queen’s University

Learning Objectives:

• Describe efforts to reduce low-value lab testing  
• Illustrate successful examples of implementation efforts to decrease low-value lab testing  
• Identify tools and resources that can support clinicians in reducing unnecessary lab testing

Abstracts on Understanding the Barriers to Overuse

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature abstracts on the perceptions and barriers to reducing overuse.

Reduction in Arthroscopy for Degenerative Knee Disease after Implementation of Surgeon Level Reporting
Dr. Eric Bohm, Orthopedic Surgeon and Associate Professor, University of Manitoba

Understanding Patient Perspectives on Evidence-Based Care for Low Back Pain Care: A Qualitative Descriptive Study
Krystal Bursey, Graduate Research Assistant, Memorial University

Barriers and Facilitators to Appropriate Use of Routine Laboratory Tests: A Qualitative Assessment
Onyebuchi Omodon, Researcher, Western University and Dr. Anshula Ambasta, Faculty of Medicine, University of British Columbia

Understanding Low-Value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals
Dr. Gillian Parker, Research Lead, Centre for Sustainable Health Systems

Learning Objectives:

• Describe research findings on perceptions and barriers to reducing overuse in different practice settings
• Discuss potential strategies for overcoming barriers to reducing overuse

Patient Engagement in Choosing Wisely: Past, Present and Future

Dr. Rebecca Metcalfe and Amy Ma will share how they are expanding patient engagement at Choosing Wisely. Stefanie Linklater and D’Arcy Duquette will discuss lessons they’ve learned about patient engagement in de-implementation research.

Dr. Rebecca Metcalfe, Research Associate, Choosing Wisely Canada
Amy Ma, Public and Patient Advisor
Stefanie Linklater, Research Program Manager, Ottawa Hospital Research Institute
D’Arcy Duquette, De-Implementing Wisely Research Group

Learning Objectives:

• Describe the evolution of Choosing Wisely Canada patient and public engagement efforts
• Identify opportunities to engage patients in resource stewardship efforts
• Apply best practices for patient engagement to multiple settings

In 2022, Choosing Wisely Canada and the Canadian Institute for Health Information released a report on overuse in Canada. While some areas show reductions, variation among provinces and territories shows there’s still room for improvement. This expert panel will discuss the report findings, current trends, and future thinking about the state of overuse in Canada. 

• Kathleen Morris, Vice President, Research and Analysis, Canadian Institute for Health Information 
• Dr. Christine Soong, Hospital Medicine Division Head, Sinai Health
• Dr. Shannon Ruzycki, General Internist and Associate Professor, Cumming School of Medicine, University of Calgary

Learning Objectives:

• Describe the problem of overuse in Canada and efforts to address this complex problem in health care 
• Illustrate successful examples of implementation efforts to reduce overuse in pre-operative testing and benzodiazepine prescribing 
• Identify opportunities to scale up implementation efforts to address variations among provinces

Learn how to tackle overuse in your practice through hot topic sessions and abstract presentations featuring innovative approaches from across the country.  

Learning From Big Data to Support Pandemic Response and Recovery

Learn how leveraging big data can inform effective strategies for pandemic response and recovery to reduce overuse and improve clinician practice.

Dr. Fahad Razak, Clinician Scientist, Unity Health Toronto

• Recognize the importance of integrating existing clinical data repositories as a tool to improve clinician practice
• Describe opportunities to harness data from hospital electronic medical records to improve clinician practice
• Discuss system integration and improving the functionality of electronic records and related data tools to support a data driven approach to reducing overuse

Designing De-Implementation Interventions Using Implementation Science

How can we apply implementation science to reduce unnecessary tests and treatments in health care? Learn about designing evidence-based strategies to de-implement common and routine practices that do not add value to patient care.

Dr. Andrea Patey, Senior Research Associate, Ottawa Hospital Research Institute

Learning Objectives:

• Learn about current evidence supporting de-implementation intervention strategies
•  Become familiar with how intervention designers have typically selected de-implementation strategies
• Understand taxonomies of intervention strategies and see how they connect to barriers
• Practice identification of de-implementation strategies from intervention descriptions

Abstracts on Reducing Overuse in Hospitals

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature implementation efforts to reduce overuse in hospital settings.

Less Is Best: Provincial Spread of Bronchiolitis Appropriate Care in Alberta
Nathan Solbak, Project Manager at Physician Learning Program

Low-Value Clinical Practices in Trauma Care: Inter-Hospital Practice Variations
Dr. Lynne Moore, Faculty of Medicine Université Laval

Toward Effective Blood Bank Resource Utilization: Creating An MSBO for NSHA
Bridgette Chan and Sina Sedighi, Dalhousie University

Learning Objectives:

• Describe efforts to reduce low-value tests and treatments in hospital settings
• Illustrate successful examples of implementation efforts in hospital settings
• Identify tools and resources that can support clinicians in reducing unnecessary testing and treatments in hospitals

Choosing Wisely in Nursing

Nurses make up nearly half of all health care professionals in Canada and play a major role as leaders and advocates in reducing overuse of unnecessary tests, treatments and interventions. Holly Rector and Katherine Trip will highlight the role of nursing professionals in quality improvement, education, and advocacy efforts to reduce overuse in practice. 

Holly Rector, Nurse Practitioner, Women’s College Hospital
Katherine Trip, Nurse Practitioner, University of Toronto

Learning Objectives: 

• Recognize the importance of interprofessional collaboration in reducing overuse
• Describe potential strategies for building nursing leadership in implementing Choosing Wisely Canada recommendations 
• Highlight specific examples of successful Choosing Wisely Canada initiatives led by interprofessional teams 
• Articulate opportunities for nursing and advanced practice nursing involvement with Choosing Wisely Canada initiatives

Learn how to tackle overuse in your practice through hot topic sessions and abstract presentations featuring innovative approaches from across the country.

Audit and Feedback: The Alberta Experience

Audit and feedback is an effective strategy that helps clinicians have an understanding of ordering patterns in comparison to their peers. Explore how advancing this effective strategy in practice can help drive change and improve health outcomes for all.

Dr. Kelly Burak, Specialist in Gastroenterology and Hepatology
Sampson Law, Physician Learning Program

Learning Objectives:

• Define Audit & Feedback (A&F)
• Identify strategies that can be used to engage physicians in A&F
• Describe how facilitated A&F, using the Calgary Audit and Feedback Framework, can increase the effectiveness of A&F

Using Labs Wisely: 100 Hospitals Later

Using Labs Wisely launched one year ago as a national collaborative to change the lab utilization landscape in Canada. With over 100 hospitals later, how are sites tackling low-value lab testing and what lessons can we learn to spread these efforts further across the country? 

Dr. Adina Weinerman, General Internist, Sunnybrook Health Sciences Centre
Dr. Felix Leung, Clinical Biochemist, Sinai Health

Learning Objectives:

• Describe the Using Labs Wisely program and how the program is changing the national landscape of lab utilization 
• Summarize unique resources provided to participating hospital labs, including comparative reports
• Explain lessons learned from a Using Labs Wisely site after one year of participation in the program

Abstracts on Antibiotic Stewardship

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature implementation efforts to reduce unnecessary antibiotic prescribing.

Harnessing Prescription Antibiotic Dispense Data to Improve Physician Prescribing Practices in Alberta
Fizza Gilani, Program Manager, College of Physicians and Surgeons of Alberta

Population-Based Assessment of Antibiotics Prescribing by Dentists in Manitoba
Dr. Aaron Quach, Canadian Armed Forces

Barriers to Using Evidence-Based Antibiotic Prescription Guidelines in Primary Care: A Qualitative Systematic Review and Synthesis
Krystal Bursey, Graduate Research Assistant at Memorial University

Reducing Inappropriate Antibiotic Prescribing in Patients With Neurogenic Bladder: A Quality Improvement Initiative
Kathy Zhang and Elnaz Assadpour, Schulich School of Medicine & Dentistry

Learning Objectives:

• Describe efforts to reduce unnecessary antibiotic prescribing
• Illustrate successful examples of implementing antimicrobial stewardship projects
• Identify tools and resources that can support clinicians in reducing unnecessary antibiotic prescribing

Choosing Wisely in the Emergency Department

Emergency Departments (EDs) are one of the highest-volume areas of a hospital. Dr. Lucas Chartier and Dr. Tahara Bhate will share how to apply quality improvement strategies in the ED and more broadly in hospital settings to free up resources and alleviate pressures.

Dr. Lucas Chartier, Emergency Physician, University Health Network
Dr. Tahara Bhate, Emergency Physician, University Health Network

Learning Objectives:

• Summarize current tests and treatments commonly over-ordered in emergency medicine settings
• Identify quality improvement areas and strategies for implementing Choosing Wisely recommendations in emergency medicine settings
• Describe potential barriers to improvement efforts in emergency medicine settings

Climate change has been described as the defining crisis of our time. In this plenary closing address, Dr. Levinson shares insights on how clinicians are uniquely positioned to take leadership in tackling the climate crisis by reducing overuse in practice. Learn more about the co-benefits of reducing waste, harm, and our environmental impact.

Dr. Wendy Levinson, Chair, Choosing Wisely Canada and Dr. Kaveh Shojania, Sunnybrook Health Sciences Centre 

Learning Objectives:

• Recognize the role of Choosing Wisely in environmental sustainability 
• Describe practical approaches to embedding environmental sustainability in different practice settings