At North York General Hospital (NYGH), 40% of all lab tests came from the emergency department (ED). Among those, almost 50% were ordered through medical directives. While medical directives are utilized to support quality patient care and flow within the department, ordering unnecessary lab tests must be avoided. NYGH found that unnecessary testing was associated with outdated medical directives, inappropriate utilization of medical directives, and inconsistent ordering habits. As an early adopter of the Choosing Wisely initiative, NYGH implemented a campaign in 2014 to improve the appropriateness of tests ordered in the ED.
The process involved revising and updating ED medical directives and incorporating the latest evidence-based practices, including Choosing Wisely Canada recommendations. The campaign engaged ED and lab staff at all levels and was accompanied simultaneously by educational and awareness activities. With the introduction of the newly updated medical directives, the ED has experienced and maintained a 23% reduction of total ED lab testing over 2 years.
The Give the Test a Rest toolkit contains the key ingredients of their approach.