Choosing Wisely at Island Health: Reducing Unnecessary Variation in Care

Choosing Wisely is an international initiative that seeks to promote dialogue on avoiding unnecessary medical tests, treatments, and procedures. In 2019, Island Health made a commitment to join the Becoming a Choosing Wisely Hospital campaign and was awarded Level 1 Designation in 2020.

Through engagement with medical staff including two island-wide virtual symposiums and through our commitment to quality improvement, the Choosing Wisely movement at Island Health is building momentum.

Choosing Wisely Canada (CWC) has over 400 recommendations published across a large number of clinical specialties and has developed many helpful patient resources.

Opportunity continues to grow for medical staff to engage with Choosing Wisely at Island Health sites and in the community as we work together to reduce unnecessary variation in care. Email MedStaffQI@islandhealth.ca to find out how you can get involved today!

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Want the latest news on Choosing Wisely at Island Health? 

We invite you to join our Choosing Wisely at Island Health Community of Practice on Yammer for the latest updates on current work and opportunities for participation and engagement! This forum presents an opportunity to connect with your colleagues and discus how you choose wisely in your daily practice.

To read more about current initiatives happening at Island Health subscribe to our newsletter or click to expand the headings below.

Medical Staff Quality Newsletter 

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Choosing Wisely at Island Health Newsletter, Summer 2021

Choosing Wisely at Island Health Newsletter, Spring 2021

Choosing Wisely at Island Health Newsletter, Winter 2021

Want to subscribe? Click here to join our mailing list and never miss an issue.

Are you involved in Medical Staff Quality Improvement or Choosing Wisely work that you would like to have highlighted? Please email MedStaffQI@islandhealth.ca

Choosing Wisely Community of PracticeJoin the conversation as we work for change!

We invite you to join the Choosing Wisely at Island Health Community of Practice on Yammer.

Discuss areas of interest for improvement and learn how you can get involved. Learn more about opportunities for engagement within Island Health and connect with like-minded individuals to discuss Choosing Wisely recommendations. Get the latest updates as we work towards achieving Level 3 CWC Designation. Build connections and share everyday Choosing Wisely involvement.

Yammer is available as an app on your smartphone and can be accessed using your internet browser. *Island Health login is required to join.*

Please contact Sarah Porter at MedStaffQI@islandhealth.ca if you have any questions about the Community of Practice.

 

Prospects and Projects: Our Path Forward

Medical staff and multidisciplinary team members at Island Health are driving change and choosing wisely everyday. Quality improvement does not happen in isolation.

Expand the headings below to learn more about how the Choosing Wisely Oversight Committee is implementing improvements guided by CWC and to find areas where you can become involved.

If you are interested in joining the movement to reduce unnecessary variation in care or wish to share other Choosing Wisely work occurring in your practice please email MedStaffQI@islandhealth.ca.

How does the Oversight Committee choose projects?

The Choosing Wisely at Island Health Oversight Committee aims to engage medical staff in CWC recommendations and support island-wide reduction of unnecessary variation in clinical practice through best practice and quality improvement.

Our journey to become a Choosing Wisely Canada designated hospital requires island-wide adoption of CWC recommendations through quality improvement methods, including the collection of baseline data, implementing the intervention, and collection of results data.

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Subject matter expert groups work alongside Clinical Analytics to analyze current state, identify change ideas, spread awareness of best practice and champion change.

The Oversight Committee is committed to sharing progress on initiatives and achieving CWC designations such as becoming a Choosing Wisely Canada designated hospital, Using Blood Wisely and Using Labs Wisely.

Transfusion Medicine: Improving Together

Led by the Blood Transfusion Committee, Dr. Brian Berry, and Dr Jennifer Duncan, Island Health is ensuring best practice is built into our prescription practices for blood products and improving transfusion processes.

The current focus of this work includes management of GI bleeds according to transfusion best practices.

If your area of practice involves prescribing blood products consider working together with the Blood Transfusion Committee and the Oversight Committee to champion this change! Email MedStaffQI@islandhealth.ca for more information.

Do you want to learn more about Transfusion Medicine at Island Health? Visit the Transfusion Medicine page on the Island Health Intranet. *Island Health login is required*.

Resources include:

Are you looking for more information? CWC has worked alongside the Canadian Society for Transfusion Medicine to develop recommendation videos specific to CWC recommendations for appropriate use of blood products. Click here to view the 5 videos.

Maintaining Improvement and Supporting Practice Change: INR-PT/aPTT Ordering

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.

The Island Health Transfusion Medicine intranet page is updated regularly. *Island Health login required*.

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Resources to Maintain Improvement and Support Practice Change 

ER Coagulation Testing QI Project to Improve Test Ordering Practice - Pamphlet

ER Coagulation Testing QI Project to Improve Test Ordering Practice - Poster

Electronic Fetal Monitoring in Labour

Are you involved in perinatal health? Do you clinically support labouring people? Considering joining us as we champion change and follow the CWC recommendation “Don’t do electronic fetal monitoring (EFM) for low risk women in labour; use intermittent auscultation”.

Our panel of experts have conducted a current state analysis of EFM usage at Island Health alongside Clinical Analytics. This analysis included applying the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommendations for when EFM is recommended or should be considered to ensure healthy delivery.

Currently the group is working to develop and implement island-wide strategies and change ideas to reduce unnecessary EFM usage. Email MedStaffQI@islandhealth.ca to learn more about how you can get involved!

Abnormal Results Rate: Appropriate Ordering of Lab Tests

This was our most popular breakout session at the Choosing Wisely at Island Health virtual symposium on November 26, 2021! 

We are in the early stages of developing a measure to guide improvements in appropriate lab test ordering. The work continues to progress and participants from the November 26 symposium are invited to continue the discussion and help develop key measures.

Did you attend the symposium? 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.

Antipsychotic Use and Dementia in Acute Care

Island Health medical staff and our multidisciplinary team members have shown incredible interest in appropriate antipsychotic use and prescribing for seniors in acute care. This topic was one of the most talked about sessions at both the 2020 virtual symposium and our most recent event on November 26, 2021!

The work guided by the Oversight Committee and our expert panel is aligned to components of the broader Island Health Seniors Strategy. This project is in early stages as the subject matter experts focus on developing appropriate measures and potential next steps in “as required” (PRN) ordering.  

Email MedStaffQI@islandhealth.ca for more information, including opportunities for involvement

MRI Ordering

Early surveying of medical staff interest in Choosing Wisely identified MRI ordering as an area of focus. Medical staff at Island Health and in communities across the island are interested in reducing unnecessary testing for patients, reducing overuse of resources, and ensuring we get the right image at the right time.

Through successful discussion at our virtual symposiums and through conversation with Medical Imaging experts and orthopedic surgeons at Island Health, we have some initial ideas on how to move this work forward and are looking for more input into how we can improve MRI ordering in alignment with the provincial requisition project.

We are looking for community providers, medical staff, and multidisciplinary team members with insight into MRI ordering to help move this work forward. Email MedStaffQI@islandhealth.ca to see how you can help drive this important work.

Patient-Centred Public Awareness Communications Campaign

Choosing Wisely is, at its heart, an awareness campaign. With over 400 recommendations published across a large number of clinical specialties and a selection of helpful patient resources, the amount of information can be overwhelming and hard to navigate.

Inspired by the “Lessons from Creating a Thriving Choosing Wisely Program & Culture in a Community Hospital” presentation by Dr. Renato Pasqualucci and Dr. Charles Winegard at the CWC National Meeting in May 2021, our Patient-Centred Public Awareness Communications Campaign aims to utilize patient perspective and the expertise of providers to highlight low-risk tests and treatments that may be unnecessary.

By increasing awareness and promoting conversation between providers and patients around appropriate care for the benefit of the patient, we can help reduce unnecessary testing and treatments and generate understanding of the right test at the right time. 

Email Sarah Porter at MedStaffQI@islandhealth.ca or click here to learn more about the campaign and find out how you can help spread awareness in your community.

Clickhere Choosing Wisely at Island Health Patient-Centred Public Awareness Campaign

 

Using Labs Wisely: Implementing Best Practice

Using Labs Wisely is a new designation offered by Choosing Wisely Canada and the Oversight Committee has joined this collaborative movement to reduce low-value laboratory testing. 

Using Blood Wisely: A Site Based Approach

The Choosing Wisely at Island Health Oversight Committee together with the Blood Transfusion Committee has joined the Using Blood Wisely Campaign with CWC, the "Choosing Wisely Canada's Hospital Designation Program", Using Blood Wisely designation is achieved when specific criteria set by Choosing Wisely Canada are met:  

  • At least 65% of red blood cell transfusion episodes are single unit.
  • At least 80% of inpatient red blood cell transfusions have a pre-transfusion Hb 80g/L or less.

A site-based approach is underway.  Nanaimo Regional General Hospital will be the first to enroll, with Campbell River Hospital also exploring this designation.

This important work will ensure Island Health is meeting national benchmarks for transfusion medicine and doing our part to protect our national blood supply.

Do you want to learn more about Transfusion Medicine at Island Health? Visit the Transfusion Medicine page on the Island Health Intranet. *Island Health login is required*.

Email MedStaffQI@IslandHealth.ca to find out more.

Choosing Wisely in Practice: Medical Staff and Program Led Work

The work of the Choosing Wisely Oversight Committee to promote standardization and reduce unnecessary tests and treatments is only the tip of the iceberg. Many medical staff and providers in the community are committed to choosing wisely every day.

To highlight some of this amazing work expand the headings below and read more about physician and program led projects and initiatives that are underway to improve patient care.

Are you involved in work to implement Choosing Wisely recommendations and spread awareness in your area? Do you Choose Wisely as a provider and incorporate recommendations into your every day practice? Spread the word by emailing MedStaffQI@islandhealth.ca and have your efforts highlighted on the website and in our Medical Staff Quality Newsletter.

Small Changes, Big Impacts! Working with order sets to reduce opioid prescribing

The dedication of medical staff is driving change island-wide as we Choose Wisely and follow best practice recommendations every day. 

Read below to learn about the amazing work led by Dr. Kevin Martin at Nanaimo Regional General Hospital to reduce hydromorphone prescribing using order sets at admission.

The Oversight Committee has a keen interest in this work as there is potential for alignment with the Antipsychotic Use in Dementia in Acute Care project as we investigate “as required” (PRN) medication ordering.

Email MedStaffQI@islandhealth.ca if you would like to learn more about this important work.

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Clickhere Small Changes, Big Impacts! Order Set Revision Inspires Quality Improvement Project Infographic

 

Promoting Planetary Health and Reducing Unnecessary Waste

Planetary Health is not currently a specific campaign of Choosing Wisely Canada, but reducing unnecessary waste and promoting a sustainable future is a shared goal and Choosing Wisely Canada is paying close attention to Climate Change initiatives.

Dr. Caroline Stigant and Dr. Jean Maskey presented The Climate Crisis and Working Towards a Model of Planetary Health Medical Practice in Victoria Hospitals – Getting it on Our Agenda on June 25, 2021 and again during the Choosing Wisely at Island Health Symposium on November 26, 2021 to discuss the impacts of health care to the climate crisis.

If you missed the talk, or if you attended and wish to revisit some of the points, please click here to view the slide deck.

Dr. Caroline Stigant and Dr. Jean Maskey are progressing this work through the South Island MSA FEI funding.

Want to learn more about Green Initiatives at Island Health? Visit the Green Island Health Intranet page. *Island Health login is required*.

We invite you as medical staff from all areas of practice to discuss ways you can reduce waste while providing optimal patient care and mitigating negative environmental impacts of the health care delivery system!

Email Dr. Caroline Stigant or Dr. Jean Maskey to learn more.

Clickhere The Climate Crisis and Working Towards a Model of Planetary Health Medical Practice in Victoria Hospitals – Getting it on Our Agenda
Presentation by Dr. Caroline Stigant and Dr. Jean Maskey
 
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Resources on Environmental Sustainability:

Sustainable Health Systems Community of Practice: Environmentally Sustainable Opportunities for Health Systems
Key areas of opportunity in sustainable healthcare. Some of the opportunities highlighted, including strategies to reduce waste in operating rooms, are in alignment with Choosing Wisely Canada recommendations. Led by the Toronto Academic Health Science Network (TAHSN) and the University of Toronto’s Council of Health Science (CHS).

Ensuring Patient Wishes and Goals are Expressed, Heard, and Respected

Advanced Care Planning (ACP) is an increasing focus in healthcare and within the patient population. Campaigns including “Speak Up: Advanced Care Planning in Canada initiative” and the Choosing Wisely recommendation “Don’t delay advance care planning conversations” are ensuring the topic remains a priority.

ACP can improve patient and family satisfaction, increase the likelihood of receiving hospice care, and reduce the number of days spent in hospital receiving end of life care. Data suggests that 75% of Canadians would prefer to die at home, but a planned home death is impossible without engaging in a robust advance care planning process. It is estimated that less than one in five Canadians has an advance care plan.

Island Health considers ACP an essential component of good patient care. Advance Care Planning leaders work in partnership with programs across Island Health to ensure resources are in place for providers and patients to have conversations about patient values, goals, and preferences for their care and to utilize these to plan care for the present and the future. Using quality improvement methods the ACP/MOST Steering Committee is engaging with staff, medical staff, and programs island-wide to encourage provider-patient ACP conversations.

Metrics related to “Expressed, Heard, and Respected” components of patient care will soon be available on the ReportPORTAL so medical staff can see how their sites and programs are engaging with patients for ACP.  *Island Health login is required.*

Resources are available to support health care providers in having conversations with patients on the Intranet Advanced Care Planning page. *Island Health login is required.*

Want to learn more about Advance Care Planning and Health Care Consent? An eLearning Course is available on the Learning Hub and is recommended for all health care providers governed by the Health Professions Act and Social Workers Act.

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Sign up today to take "Advance Care Planning and Health Care consent".

Visit the Island Health Intranet for more information and resources on Advanced Care Planning and how to make the MOST of patient care. *Island Health login is required*.

Email MedStaffQI@islandhealth.ca for more information.

Resources and Tools for Improvement

Are you looking to make changes in your area? Are you passionate about quality improvement? Expand the headings below to learn more about some resources available to you to expand your quality improvement toolbox.

Do you want to learn more? Visit the External Resources page on the Medical Staff Website to learn about some external funding opportunities facilitated through Island Health and become a champion for change.

Getting started with Physician Quality Improvement

Are you a medical staff member interested in Quality Improvement but are not sure where to start?

Register for Level Two Physician Quality Improvement (PQI) Fundamentals – a two-day virtual workshop introducing Quality Improvement and teaching you the skills you need to get started.

Visit the Level Two – PQI Fundamentals page on the medical staff website to learn more about upcoming opportunities to bring your ideas to the next level.

This virtual session is CME approved for 7 hours and sessional payments are available for fully-licensed GPs and SPs for up to 8 hours.

Visit the Physician Quality Improvement page to learn more about opportunities to get involved with PQI or email PQI@islandhealth.ca

Interested in learning about QI at your own pace from a world-class institution? We offer free access for medical staff to the Institute for Healthcare Improvement (IHI) Open School.

Not sure where to start? We recommend Quality Improvement 101-103! Please contact pqi@islandhealth.ca for a complimentary registration code.

For Island Health employees contact Erin.Craig@islandhealth.ca for a registration code.

 Island Health Report PORTAL: Supporting Quality Improvement

Are you looking for data to support quality improvement Work? Have you visited the Report PORTAL accessible through the Island Health intranet? This resource includes site level data available on the Island Health performance dashboard, organizational priorities, patient flow and more.

The material contained and linked in the Report PORTAL is for internal Island Health use, for work associated with understanding, monitoring, and improving the health system only. Use of this information for research is not permitted. For opportunities related to Research please contact Island Health Research & Capacity

To view measures related to Choosing Wisely:

1. Login to the Report PORTAL using your Island Health Login: https://reports.viha.ca/

2. Navigate to ‘Quality Improvement’

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3. View reports located under the heading ‘Medical Quality’.

Your Island Health Network login is required to access the site.

Please contact DataRequest@islandhealth.ca if you have any questions about Report PORTAL or to access specific reports.

Clickhere Visit the Choosing Wisely Achievements at Island Health page to read more about past achievements and our two virtual symposiums.

For the most up to date news on Choosing Wisely at Island Health, please join our Choosing Wisely at Island Health Community of Practice on Yammer or email MedStaffQI@islandhealth.ca