SickKids launches phase two of Choosing Wisely with five additional tests and treatments patients and providers should question
Following successful reductions of the use of uncomfortable nasal swabs and routine unnecessary x-rays for ankle injuries, among others, The Hospital for Sick Children (SickKids) is poised to launch phase two of our Choosing Wisely campaign.
It’s well known now in the health care community that a portion of tests and treatments do not add value to care, and in some cases cause unnecessary discomfort and potential harm; it is estimated up to 30 per cent of investigations and procedures in North America could fit this description.
We joined with Choosing Wisely Canada in 2016 and launched our own initiative at SickKids with a list of five things physicians and patients should question. Because SickKids cares for some of the most critically ill children, our unique environment and patient population made it necessary to establish a new list of tests and treatments more specifically used in paediatric acute hospital care.
With clear plans for action, the programs that were implemented in 2016 have driven notable reductions in the following areas:
- We have decreased the rate of IVIG use from 88% to 50% by not automatically giving IVIG as first-line treatment for children with newly diagnosed, typical ITP.
- We have decreased nasopharyngeal testing for respiratory viruses by more than 80% in the Emergency Department (ED) and by 27% for patients admitted to General Paediatrics.
- We have decreased routine radiography for children with low-risk acute ankle injuries from 90% to 53% in the ED.
With our successes in mind, and learnings from the launch of phase one, the Choosing Wisely team turned to identifying items for the phase two list.
“This year we have really broadened the reach of Choosing Wisely at SickKids to areas beyond Paediatrics and the ED. Projects involving surgery, intensive care and others have been brought into the fold to ensure the Choosing Wisely program is truly hospital-wide,” says Dr. Jeremy Friedman, Associate Paediatrician-in-Chief.
The list has been developed through consultation with a diverse group of 250 stakeholders across SickKids. Some of the items on the new list share a common thread; there is increased focus on antibiotic stewardship and that is reflected by the inclusion of three antibiotic-focused recommendations. This aligns nicely with the work being done by the Hospital’s Antimicrobial Stewardship Program (ASP).
Learning from the implementation of the first phase, there has been greater focus on identifying and onboarding physician and health-care provider champions at the outset. The involvement of physicians, trainees, nurses, laboratory technicians, pharmacists and allied health champions is also critical to success.
“It’s imperative that we continue to improve patient care and safety by consolidating the impressive improvements we have seen in more appropriate use of the first five tests and treatments; the work in those areas isn’t over, but we are adding five more recommendations to expand the impact of this work in further improving the quality of care and safety for our patients,” notes Friedman.
Overall, the purpose of Choosing Wisely is to encourage providers to engage in conversations and critical thinking around the tests and treatments they order for patients. The full list of SickKids' recommendations can be found in the PDFs below.