This past year, Scarborough Health Network (SHN) achieved designation as a Choosing Wisely Canada Hospital at the Quality Improvement level. A recognized early adopter of Choosing Wisely, SHN has led quality improvement initiatives that are producing measurable benefits to patients, the health system, and the planet. We connected with Laura Kane, Manager of Quality and Clinical Standardization, and Dr. Thomas Bodley, Quality Lead for Critical Care Medicine, to learn more about the significance of the designation and SHN’s next steps in driving improvements.

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Choosing Wisely Canada: Tell us a bit about how your hospital got involved in Choosing Wisely or more specifically, reducing overuse/low-value care?

Laura Kane & Thomas Bodley: SHN was an early adopter of Using Labs Wisely and Using Blood Wisely philosophies well before embarking on our formal Choosing Wisely journey. We have always been focused on providing the “right care, to the right patient, at the right time,” and this sometimes means avoiding tests or procedures that are either harmful or wasteful. Choosing Wisely principles have therefore resonated with our organization from leadership through to front-line staff.

Lab testing stewardship at SHN began as early as 2008 when CK-MB was removed at Centenary Hospital. This effort was driven by a desire to focus resources on higher-value testing, such as high sensitivity troponin to improve cardiac care for our patients. Between 2015 and 2021, we embarked on a series of initiatives to reduce other low-value lab testing related to AST, Folate, Urea, Fecal Occult Blood Testing, and ESR. Similarly, Using Blood Wisely work started in 2016 with the endorsement of SHN’s Blood Transfusion Committee and leveraging a variety of toolkits and interventions from Choosing Wisely. This work continued and evolved across all three SHN hospitals, and SHN received its Using Blood Wisely Hospital designation in July 2023.

More recently, SHN made it a key strategic priority to obtain our Choosing Wisely Canada Hospital Designation in Quality Improvement. The formal Choosing Wisely journey helped us organize around a number of different projects, such as our IV medication stewardship program, which resulted in a 33% and 20% reduction in the use of IV pantoprazole and levetiracetam, respectively. We also joined the Using Labs Wisely collaborative and implemented our “Pause the Draw” lab stewardship program, reducing unnecessary blood testing across SHN ICUs by 15% over 12 months and saving over 60,000 tubes and plastic bits/year.

CWC: What motivated your hospital to pursue the Choosing Wisely Canada Hospital QI Status?

LK & TB: Our Senior Leadership Team members were strong advocates for pursuing the Choosing Wisely Canada Hospital Quality Improvement Status, including incorporating the initiative into SHN’s Strategic Plan 2024–2029. Pursuing this designation reflects our commitment to advancing initiatives that prioritize patient safety and evidence-based care.

CWC: What does the QI Status represent to your hospital?

LK & TB: This honours and underscores SHN’s dedication to optimizing healthcare resources and delivering high-quality, efficient and safe patient care. It also embodies SHN’s culture of innovation and continuous quality improvement. Through Choosing Wisely Canada, we are actively demonstrating our focus on continuously identifying opportunities to improve care delivery, minimize risk, and ensure that every decision is grounded in patient-centred values.

CWC: In the future, how do you plan to continue Choosing Wisely efforts?

LK & TB: As we look ahead to SHN’s 2026-2029 Quality and Patient Safety Plan, we aim to embed the principles of Choosing Wisely and continue to spread the implementation of Choosing Wisely recommendations broadly across the organization. Rooted in our Quality and Patient Safety Plan are priorities that align well with Choosing Wisely’s mandate for reducing unnecessary tests and treatments. To support this work locally, we have established the SHN Choosing Wisely Committee to identify ways to implement, sustain, and spread Choosing Wisely recommendations at SHN and identify priorities for a Regional Utilization Advisory Group.

This new Regional Utilization Advisory Group is led by SHN and aims to look at ways to implement Choosing Wisely recommendations across our partner organizations in the Central East Ontario Health cluster, who share the same Epic clinical information system For example, we have engaged peer hospitals in expanding the Pause the Draw program and are looking to integrate order set modifications within our shared Epic system. As the SHN Choosing Wisely team expands our efforts to reduce low-value care, we are interested in pursuing Choosing Wisely Canada’s Hospital Designation at the Leadership level in the near future. Beyond spreading initiatives broadly across SHN’s multi-hospital network, we want to ensure that patients across the region experience the same positive impacts.