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 participation in Knowledge to Action Month in partnership with Island Health Research, 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 to find out how you can get involved today!


Prospects and Projects: Our Path to Quality Improvement Designation as a Choosing Wisely Hospital

The Choosing Wisely at Island Health Oversight Committee has three main areas of focus on our journey to achieve Quality Improvement Designation as a Choosing Wisely Hospital including Using Blood Wisely, Using Labs Wisely, and Reducing Antipsychotic Prescribing for seniors with dementia in acute care.


Are you interested in learning more? We invite you to watch a recording of “Choosing Wisely: Climate Conscious Quality Improvement in Action” to hear from the Choosing Wisely at Island Health Oversight Committee about these three important initiatives. Our aim to improve experience of care for patients and providers by choosing wisely is built on the 4 pillars of climate conscious healthcare, reducing unnecessary variation in practice, addressing resource challenges and using quality improvement methodology.  

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


Choosing Wisely: Climate Conscious Quality Improvement
in Action -  November 18, 2022

Our third annual Choosing Wisely at Island Health Session was
hosted in partnership with Island Health Research as part of the
10th Annual Knowledge-to-Action Month.
The event was made possible through Health System Redesign (HSR).
HSR is supported by three Joint Collaborative Committees of Doctors of BC and
the Ministry of Health: Shared Care, Specialist Services, and General Practice
Services Committees.  

Using Blood Wisely: An Island-wide Initiative

Using Blood Wisely is a national campaign to decrease inappropriate red blood cell transfusion practices in Canada. The goal is to achieve national benchmarks for inpatient transfusion practices of single unit red blood cell transfusion episodes of at least 65% and a pre-transfusion Hb 80 g/L or less in at least 80% of inpatient red blood cell transfusions.

Data for all sites is available on the Report PORTAL. *Island Health login is required*

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

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

We have developed two new resources on Using Blood Wisely at Island Health including a one-pager with Key Messages and an Overview document. Both are formatted for easy printing. Click on the links to learn more.

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 to find out more

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.


Educational Materials – Why Give 2 When 1 Will Do?:

Using Blood Wisely – Key Messages: A one-pager focusing on reducing inappropriate red blood cell transfusions using evidence-based guidelines.

Using Blood Wisely – Overview: A one-pager poster providing guidance on how to Use Blood Wisely.


**Island Health login is required**

Using Blood Wisely: Decrease inappropriate red blood cell transfusion practices in Canada is located
on the ‘Quality Improvement’ section of the Report PORTAL under the heading
‘Medical Quality’.
(Updated October 2022)


Using Labs Wisely: Implementing Best Practice through Unbundling

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

  1. Implement Change to promote lab stewardship,
  2. Share aggregated lab utilization data on a defined set of tests, and
  3. 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 with a focus on reducing lab test bundling, which is no longer considered best practice. Through this approach we are aiming to reduce AST tests, reduce urea tests and ensure appropriate coagulation testing in both emergency departments and inpatient units.

Appropriate lab test ordering resonates with Medical Staff, and our session on Abnormal Results Rate was the most popular breakout session at the November 2021 virtual symposium.

Data for all sites are available on the Report PORTAL*Island Health login is required*


Educational Materials:

Unbundling with Using Labs Wisely: A one-pager focusing on the unbundling and appropriate ordering of AST/ALT and urea/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


**Island Health login is required**

Using Labs Wisely: Unbundling of Lab Tests is located
on the ‘Quality Improvement’ section of the Report PORTAL under the heading
‘Medical Quality’.
(Updated October 2022)

Clickhere We invite you to visit our Using Labs Wisely at Island Health page for more detailed information on this work.

Are you interested in using quality improvement to promote appropriate ordering of lab tests? Email to find out how you can become involved.

Antipsychotic Use Prescribing For Seniors with Dementia in Acute Care

While there are several initiatives underway at Island Health to optimize care for seniors across the spectrum of health care services, the Choosing Wisely Oversight Committee is focusing on the CWC recommendation 'Avoid antipsychotics as first choice for insomnia, agitation or delirium in elderly patients' in our acute care facilities. This topic was one of the most talked about sessions at both the 2020 virtual symposium and our event on November 26, 2021!

Led by the Choosing Wisely at Island Health Antipsychotic Working Group, a suite of materials have been developed and distributed to support best prescribing practices across acute care facilities. A key area of focus is the elimination of quetiapine (Seroquel) prescribing for sleep, highlighting the acute and chronic harms associated with this drug, and providing non-pharmaceutical and pharmaceutical alternatives. 

The team are available to discuss current research and best practices. Educational and informational materials are available in the table below.

Data regarding Antipsychotic Use in Acute Care is available on the Report PORTAL. *Island Health login is required*


Educational Materials


Seroquel ≠ Sleep Infographic and Decision Tree

**Island Health login is required**

The Story of Mr C

Antipsychotic Use Knowledge Quiz



**Island Health login is required**

The Choosing Wisely: Antipsychotics in Acute Care data is located
on the ‘Quality Improvement’ section of the Report PORTAL under the heading

‘Medical Quality’.
(Updated October 2022)

Email for more information, including opportunities for involvement.

Choosing Wisely Projects at Island Health 

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

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

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.

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


We are currently working to achieve Quality Improvement Status as a Choosing Wisely Canada Hospital which requires five credits earned through participation in quality improvement efforts:

  1. Becoming a Using Blood Wisely Hospital (2 credits)
  2. Participating in Using Labs Wisely (2 credits)
  3. A self-directed Choosing Wisely QI project (1 credit).

In addition to earning the credits listed above, Island Health will also need to demonstrate sustained efforts and ongoing organizational commitment to Choosing Wisely for 2 consecutive years and every two years thereafter.

Once we have achieved our Quality Improvement Status designation we will begin working towards Leadership Status by adding two new self-directed Choosing Wisely QI projects to our roster.

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

Electronic Fetal Monitoring (EFM) 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”.

In 2020, the Society for Obstetrics and Gynecology added antepartum COVID-19 (SARS-CoV-2) infection to the list of considerations for continuous intrapartum fetal monitoring.  Perinatal Service BC subsequently recommended all pregnant women/individuals who have tested positive for COVID-19 at any time in pregnancy be monitored using EFM for possible fetal distress.

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.

New data for potentially unnecessary use of EFM during labour will soon be available on the Report Portal.

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

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 to see how you can help drive this important work.

Patient-Centred Public Awareness Communications Campaign

Choosing Wisely is about providing good patient care by using the right tests and treatments at the right time. 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. 

The campaign was led by a working group prioritizing equal representation between patients and providers and the pilot is set to launch in 2023 in select community sites.

At the recommendation of Island Health leadership, we are expanding the scope to develop public awareness materials featuring four Choosing Wisely Canada recommendations in emergency departments at Island Health.

The campaign was recognized at BCPSQC Quality Forum 2022 as a Storyboard Presentation and at the Choosing Wisely National Meeting in May 2022 as an innovative approach.

Email Sarah Porter at 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
Updated: November 2022

Medical Staff Quality Newsletter

The Medical Quality Newsletter is a great way to stay up to date on current projects and improvements and find out how you can get involved in this important work.


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

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 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 if you would like to learn more about this important work.


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

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).

Advanced Care Planning: Ensuring Patient Wishes and Goals are Express, 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 are available on the ReportPORTAL in the ACP MOST Quarterly Report 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.

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

**Island Health login is required**

The ACP MOST Quarterly Report can be accessed through this link.
It is located on the ‘Health Care Activity and Resources’ section of the Report PORTAL under the heading ‘Palliative & End of Life’.

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 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.

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

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 for a complimentary 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:
  2. Navigate to ‘Quality Improvement’ or bookmark the ‘Quality Improvement’ direct link for easy access.


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

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

Please contact 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.
Clickhere Visit the Using Labs Wisely page to learn more about this important initiative.

For the most up to date news on Choosing Wisely at Island Health email