Choosing Wisely was first introduced at Bluewater Health in 2013. At this time, Choosing Wisely Canada had not yet launched, but the American ABIM Foundation Choosing Wisely lists were shared with all physicians and Choosing Wisely was discussed at the Medical Quality & Utilization Committee.
Since that time, a Choosing Wisely Committee has been established, Choosing Wisely has been incorporated into each annual Bluewater Health Medical Education Symposium, and a communications strategy is used to increase awareness among the providers and also the general public.
A Choosing Wisely Committee was formed in 2016, as a sub-committee of the hospital’s Medical Advisory Committee (MAC) with the goal of proactively implementing and leading Choosing Wisely initiatives in the hospital. As its first project, the Choosing Wisely Committee asked each department to consider removing the ‘hard check’ or automatic ordering function on patient order sets related to seven common lab tests: blood urea nitrogen (BUN), aspartate aminotransferase (AST), thyroid-stimulating hormone (TSH), erythrocyte sedimentation rate (ESR), serum folate, creatine kinase (CK), and urine cultures. Pre- and post- implementation data were collected and shared with the physicians to highlight the results achieved without negatively impacting patient care. Reductions in these tests freed up laboratory resources allowing the hospital to offer brain natriuretic peptide (BNP) testing on site, a demonstration of what can be achieved when hospitals are able to reallocate resources. Dr. Renato Pasqualucci, a founding member of the Choosing Wisely work at Bluewater Health, commented that “it is important to get the buy-in of the physicians; most people want to do the right thing, by incorporating the change into the patient order sets, it supported the physician with his/her ordering patterns.”
Other successful Choosing Wisely initiatives have included the adoption of the ‘Why Choose Two’ transfusion toolkit, establishing appropriate protocols for urinalysis and urine culture testing cheekily named the ‘pee rules’, decreasing rib x-rays in the emergency department by over 40% from 2016-2017, and an interprofessional discussion with family physicians, chiropractors, physiotherapists with the goal of reducing inappropriate imaging for low back pain. Current initiatives include Using Antibiotics Wisely, reducing opioid prescribing as well as a more general hospital-wide deprescribing initiative, appropriate use of diagnostic imaging, and code status updates. Dr. Pasqualucci, is also co-leading a Local Health Integration Network (LHIN) wide strategy that will revise current opioid dispensing standards post-surgery across the Erie St Clair and South West LHIN hospitals.
Yearly, at the Bluewater Health Medical Education Symposium, the speakers are requested to incorporate Choosing Wisely recommendations into their presentations, and an information booth is available to share Choosing Wisely lists of recommendations and resources for physicians and their patients.
Recognizing that education and awareness are essential components of quality improvement, there is also an emphasis on communicating the message through different means and to different audiences. The Communications Department is an integral member of the Choosing Wisely Committee. The initiatives include a Choosing Wisely ‘tip of the month’ for physicians/nurse practitioners, which provides a tip as well as the Choosing Wisely rationale, and patient resources. Posters related to the tips are posted in the Emergency Department and shared with the general public through social media. “Providers seem to appreciate the tips since they pare down the message and present all information in one place to assist them in considering a practice change,” said Dr. Charles Winegard, Chair of the Choosing Wisely Committee. Profiles on physician champions, who share their perspectives on Choosing Wisely, are also featured on social media as well as on the hospital’s website. A video has recently been developed with physicians discussing the importance of the dialogue between the physician and the patient in wisely choosing treatment options or tests.
Bluewater Health exemplifies what it means to be a Choosing Wisely hospital, helping to spread and scale local initiatives that meaningfully improve the quality of care at their organization and beyond.