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Choosing Wisely Canada: Diving into Overuse in Hospitals Launch

On January 10th, Choosing Wisely Canada, Health Quality Ontario and the Ontario Hospital Association, in partnership with North York General Hospital, launched the Diving into Overuse in Hospitals Starter Kit, a resource that provides practical advice and guidance for reducing unnecessary tests and treatments in the hospital setting.

The contents of the starter kit are designed to help kick-start your hospital’s participation in the global Choosing Wisely movement, the Diving into Overuse in Hospitals campaign that will launch on January 31, 2019.

This campaign calls on all hospitals to join the global Choosing Wisely movement and become a designated hospital, achieving a certificate of completion for a level and national profile. Participating hospitals get access to a wealth of resources, including a starter kit, webinars and other supports. Hospitals interested in being part of this, but are not sure if they have an overuse problem are encouraged to ask themselves the five basic questions below.

 

Overuse in My Hospital: Five Questions to Ask
1.      Does my emergency department order both PT/INR and aPTT tests as a bundle?
2.      Does my hospital still use CK testing to diagnose a heart attack?
3.      Are inpatients at my hospital getting daily blood tests automatically?
4.      Does my hospital still test serum & red blood cell folate levels?
5.      Does my ICU still order routine x-rays for all patients?

 

A ‘yes’ answer to any of the questions means your hospital has an overuse problem. Even if the answers are ‘no’ across the board, the Starter Kit suggests ways hospitals can do a deeper dive to uncover other signs of overuse and what to do about it.

Unnecessary testing and treatment is a pervasive problem in health care, and can expose patients to avoidable harm, lengthen wait times, and consume precious hospital resources. A 2017 report from the Canadian Institute for Health Information showed that in many clinical areas, up to 30% of tests and treatments are potentially unnecessary.

While clinicians ultimately make decisions about which tests and treatments to order based on the assessment of an individual patient, many of these decisions can often be influenced by hospital systems and processes that, if outdated or poorly designed, can nudge clinicians toward ordering tests and treatments that do not reflect evidence-based guidelines and practices. Examples of hospital systems and processes that can drive overuse include: order sets, medical directives, lab order panels and computerized order entry systems, among others. Historical practices that have, over time, become routinized and ‘baked’ into these systems set the course of overuse on auto-pilot, often taking decision-making out of the hands of busy clinicians, for better and for worse.

The Diving into Overuse in Hospitals campaign aims to mobilize and empower hospital staff to pause, question long-standing practices and take leadership on reducing overuse, avoiding potential harm to patients and freeing up precious hospital resources for more important uses. Join the launch webinar on Thursday January 31st to learn more about the campaign as well as becoming a Choosing Wisely Canada hospital and progressing through levels 1-3.

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