For many patients and families, their journey within the health care system begins in the Emergency Department (ED). The ED provides essential care 24 hours a day, 7 days a week, every week of the year for patients who are ill, injured or require immediate attention.
Patients arrive at emergency departments injured or presenting with symptoms that they feel need to be addressed immediately. Emergency physicians require an extremely broad set of skills and clinical knowledge in order to provide effective care to just about any patient that comes through the door. Part of this care involves a full assessment where tests and treatments are ordered to determine the patient’s current condition and appropriate next steps. An important aspect of high-quality care in ED is ensuring patients do not wait longer than necessary and as such, it is critical for ED physicians and care teams to use hospital resources judiciously and only order a test and treatment when it adds value to patient care.
The Canadian Association of Emergency Physicians (CAEP) has been a leader in advocating for best practices in emergency medicine. CAEP has over 2500 members who practice in diverse settings of emergency medicine from coast-to-coast. This year, CAEP celebrates its 40th anniversary. The Association has grown considerably since its beginnings, and supports physicians and patients, fosters education and research opportunities in emergency medicine, and defines standards for quality in emergency care.
CAEP recognized the importance of partnering with Choosing Wisely Canada soon after the campaign launched in 2014. In 2015, CAEP organized an expert working group that generated a list of recommendations regarding tests, treatments and procedures for clinicians in emergency departments to avoid because they do not add value to care. The draft list of recommendations was sent to more than 100 emergency physicians for input, where 5 recommendations were selected by consensus. In 2016, CAEP released an additional 5 recommendations in phase two of their list release.
Dr. Amy Cheng is a Staff Physician in Emergency Medicine and Interim Medical Director, Quality Improvement and Patient Safety at St. Michael’s Hospital in Toronto. Dr. Cheng is also the co-chair for the Choosing Wisely Canada expert working group at CAEP that was developed to advance efforts with the campaign.
She highlights the importance of Choosing Wisely in emergency medicine in Canada.
“The ED is the point of entry into the health care system for many patients and families, and it is our role as emergency physicians to make critical, time-pressured decisions that will benefit patient care,” says Dr. Cheng. “In partnering with Choosing Wisely Canada to reduce unnecessary tests and treatments, we can allocate finite health care resources better and ensure that the right patient, gets the right care, at the right time.”
Dr. Brian Rowe is also a co-chair of the Choosing Wisely Canada expert working group at CAEP, and Professor of Emergency Medicine at the University of Alberta. Dr. Rowe believes that utilizing evidence-based decisions for the diagnosis and management of acutely ill and injured patients is essential.
“Inappropriate investigation and treatment can lead to prolonged stays, unnecessary patient risks, poor outcomes and increased health care costs,” says Dr. Rowe. “Impressive evidence has accumulated over the past 20 years to help emergency physicians do the right things, and it’s incumbent on us to use that evidence wisely.”
Beyond the list, CAEP has been busy integrating Choosing Wisely Canada into Association activities. At CAEP’s annual national meeting, a dedicated Choosing Wisely Canada session has been created to share emergency medicine-led implementation initiatives. In addition, CAEP encourages members to consider submitting abstracts based on their Choosing Wisely quality improvement efforts. Drs. Cheng and Rowe believe it’s important to include Choosing Wisely sessions in their annual meeting to keep recommendations and best practices top of mind for CAEP members.
“We wish to encourage dialogue, examine innovative methods of implementation, and look for success stories to spread and scale the movement,” says Dr. Rowe. “This is the largest meeting of emergency physicians in the country and it’s a perfect opportunity to engage clinicians and scientists.”
Most recently, CAEP is continuing its engagement with the campaign by considering future list updates to include current issues that emergency physicians are facing in clinical practice. In addition, CAEP has a number of Choosing Wisely Canada speakers that attend regional meetings and conferences to engage groups and encourage implementation. Finally, CAEP members help familiarize health students locally about the role of Choosing Wisely Canada in health sciences education.
Choosing Wisely Canada is proud to partner with CAEP and encourage best practices in emergency medicine. Through the collective efforts of emergency physicians, interprofessional care teams, and associations such as CAEP, patients can be assured that they are receiving high-quality, efficient and effective care in the ED.