Using Labs Wisely is a national consortium of hospitals committed to making a measurable impact on reducing low-value lab testing in Canada. Hospitals of various sizes and levels of experience with implementing lab stewardship projects are welcome to join Using Labs Wisely.
Participating hospitals will
- Implement Change to promote lab stewardship,
- Share aggregated lab utilization data on a defined set of tests, and
- Learn with lab experts from across the country as part of a national Collaborative.
Island Health joined the pilot phase of the collaborative in April 2022. We have identified opportunities to reduce potentially unnecessary testing through reduction in lab test bundling, which is no longer considered best practice. Through this approach we are aiming to reduce unnecessary AST and urea tests and inappropriate coagulation testing in emergency departments and inpatient units.
The topic is very popular with Medical Staff, and our session on Abnormal Results Rate was the most popular breakout session at the November 2021 virtual symposium.
Monitoring Progress and Understanding Our Impact
Accessible data is a key driver for change!
The Choosing Wisely Oversight Committee have launched a new Choosing Wisely at Island Health Interactive Report to monitor progress on key Choosing Wisely initiatives at Island Health including our Using Labs Wisely targets. Visit the report to view Island Health wide data or compare data by site. The report is hosted on the Report PORTAL. *Island Health login is required*
Beyond our own Using Labs Wisely targets, Island Health are keen to add planetary health metrics to our own data. Understanding the impact lab tests have on our greenhouse gas emissions, as well as the impact on patients and the labour associated with extra testing, is a valuable step in ensuring we are focused on ordering the right test at the right time.
The Canadian Society for Medical Laboratory Science (CSMLS) has launched a new tool in collaboration with Choosing Wisely Canada and the Using Labs Wisely Collaborative to calculate the triple bottom line for lab tests and gain a better understanding the cost, blood, and waste associated with lab tests. The Lab Wisely Calculator can be used to review specific tests, including all of our key Using Labs Wisely targets, and has been developed to provide medical professionals with evidence to aid in decision making.
We invite you to try out the CSMLS Lab Wisely Calculator by visiting this link: https://labwisely.ca/calculator.html
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Educational Materials: Unbundling with Using Labs Wisely: A one-pager focusing on the unbundling and appropriate ordering of AST/ALT and urea and creatinine. Resources to Maintain Improvement and Support Practice Change: INR-PT/aPTT Ordering ER Coagulation Testing QI Project to Improve Test Ordering Practice - Pamphlet ER Coagulation Testing QI Project to Improve Test Ordering Practice - Poster |
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Choosing Wisely at Island Health Interactive Report The Choosing Wisely Interactive Report is located |
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CSMLS Lab Wisely Calculator Explore the triple bottom line for specific lab tests to understand the impacts on climate, patients, and the health system. The CSMLS Lab Wisely pages are a fantastic resource for improving lab utilization. |
Want to learn more about how we are reducing unnecessary ordering of specific tests? Expand the headings below to read more about our quality improvement work.
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Maintaining Improvement and Supporting Practice Change: INR-PT/aPTT Ordering
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Thanks to the support and commitment of our medical staff and multidisciplinary team members Island Health successfully implemented the 5 “Quick wins” on the path to achieving Level 1 CWC Designation including the uncoupling of PT-INR and aPTT tests in the emergency department and revising ED order panels.
Dr. Brian Berry and Dr. Annemarie de Koker have developed materials in the form of a pamphlet and posters aimed at maintaining this improvement and supporting practice change for improved ordering of coagulation testing in the ER.
Further to the unbundling work, measures to improve appropriate use of PT-INR testing is underway, with many sites now showing a reduction in both aPTT and PT-INR testing, according to clinical guidelines.
Ongoing monitoring of bundled coagulation tests are available on the Report PORTAL, and further improvements to reduce PT-INR testing continue. Coagulation measures are located on the ‘Quality Improvement’ section of the Report PORTAL under the heading ‘Medical Quality’. **Island Health login is required**
For more information and guidance on when to consider ordering INR, aPTT, INR and aPTT and when coagulation testing is not appropriate, please click here to read the June 17, 2021 Memo. **Island Health login is required**
Dr. Brian Berry and Dr. Annemarie de Koker are available to speak to any groups that would like a presentation or discussion on Choosing Wisely unbundling aPTT-PT/INR in EDs and can provide further guidance on coagulation testing. Please feel free to reach out to them directly.
Resources to Maintain Improvement and Support Practice Change: INR-PT/aPTT Ordering
ER Coagulation Testing QI Project to Improve Test Ordering Practice - Pamphlet
ER Coagulation Testing QI Project to Improve Test Ordering Practice - Poster
The Island Health Transfusion Medicine intranet page is updated regularly. **Island Health login is required** -
Unbundling AST/ALT and urea/creatinine
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On our journey to achieve Using Labs Wisely status with Choosing Wisely Canada, the Choosing Wisely at Island Health Oversight Committee in partnership with Clinical Analytics conducted a current state analysis in mid-2022 to identify opportunities at Island Health in inpatient and emergency department settings to reduce potentially unnecessary lab testing.
The bundling of Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and urea and creatinine tests were identified as an area for improvement and metrics were reviewed to identify variation in practice on a site-by-site basis.
To learn more about when to order AST/ALT or urea/creatinine view our one-pager here.
Ongoing monitoring of bundled AST/ALT and urea/creatinine tests are available on the Report PORTAL, and further improvements to reduce low value lab testing continue. Using Lab Wisely measures are located on the ‘Quality Improvement’ section of the Report PORTAL under the heading ‘Medical Quality’. **Island Health login is required**
Unbundling with Using Labs Wisely: A one-pager focusing on the unbundling and appropriate ordering of AST/ALT and urea/creatinine.
Are you interested in using quality improvement to promote appropriate ordering of lab tests? Email MedStaffQI@islandhealth.ca to find out how you can become involved.
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Click here to return to the main Choosing Wisely at Island Health webpage |