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SickKids launches fourth phase of Choosing Wisely recommendations
11 minute read

SickKids launches fourth phase of Choosing Wisely recommendations


Choosing Wisely recommendations address overuse of medically unnecessary tests and treatments received by patients at the hospital.

In keeping with our commitment to Choosing Wisely and ensuring quality and accountability in everything we do, The Hospital for Sick Children (SickKids) released four new recommendations to address the potential overuse of tests and treatments received by patients at the hospital. 

In 2016, SickKids joined the Choosing Wisely campaign, an international initiative to improve high-value health care through a reduction in medically unnecessary tests and treatments, with an inaugural list of five paediatric recommendations. With increasing momentum over the past seven years, three subsequent lists of recommendations of medically unnecessary tests and treatments that clinicians and patients should question have been published, representing 19 quality improvement projects.   

“As this important work enters its eighth year at SickKids, it’s exciting to see the field of overuse and resource stewardship grow,” says Dr. Jeremy Friedman Associate Paediatrician-in-Chief and leader of the Choosing Wisely program at SickKids. “The issue of overuse does not just involve children, it truly starts with them, and as health-care professionals we must do our part in addressing the potential consequences to our patients. 

The new list has increased the program's reach even further by introducing the first psychiatry-focused recommendation from SickKids, the involvement of two general surgeons, and a joint initiative with the hospital's Caring Safely program. These additions demonstrate how the Choosing Wisely culture has spread throughout SickKids and will continue to fuel quality improvement work.  

Four more things clinicians and patients should consider


Don’t obtain screening laboratory tests in the medical clearance process of paediatric patients who require inpatient psychiatric admission unless clinically indicated.

Project leads: Dr. Adam Enchin, Medical Director, Garry Hurvitz Centre for Community Health; Dr. Krishna Anchala, Staff Physician, Paediatric Emergency Medicine, and Emergency Physician Lead, Kids Health Alliance. 

Headshots of Dr. Adam Enchin and Dr, Krishna Anchala

Don’t routinely hospitalize otherwise healthy children who are post-op from a non-perforated laparoscopic appendectomy who can be safely and more comfortably managed at home. 

Project Leads: Dr. Joshua Ramjist, Staff Surgeon, General and Thoracic Surgery; Dr. Annie Fecteau, Staff Surgeon, General and Thoracic Surgery. 

Headshots of Drs. Joshua Ramjist and Annie Fecteau
Urinary catheter

Don’t keep urinary catheters in place longer than clinically indicated in hospitalized children.  

Project leads: Dr. Maitreya (Trey) Coffey, Staff Paediatrician, Associate Chief Medical Officer, Quality and Medical Affairs; Dr. Angie Lim, Clinical Nurse Specialist, Interprofessional Practice. 

Headshots of Drs. Trey Coffey and Angie Lim
A shining letter 'D'

Don’t routinely order vitamin D levels in otherwise healthy children. Vitamin D testing is only indicated for children at risk for osteoporosis, rickets, malabsorption syndromes, renal disease and medications affecting vitamin D metabolism. Repeat testing is not indicated within three months or less for a patient with previously low results or within six months if previously normal. 

Project leads: Dr. Carol Lam, Staff Physician, Endocrinology; Dr. Krista Oei, Staff Physician, Endocrinology; Dr. Lusia Sepiashvili, Clinical Biochemist, Department of Paediatric Laboratory Medicine (DPLM).

Headshots of Drs. Carol Lam, Krista Oei and Lusia Sepiashvili

The program's continued success is a product of the highly engaged and credible champions who lead each initiative, often in collaboration with an interdisciplinary working group. Notably, the SickKids Choosing Wisely steering committee has grown from five to over 30 members, including physicians, surgeons, trainees, nursing and allied health, family advisors, and program managers since the program’s inception. With the introduction of the new list, the program has welcomed nine new clinician champions and their diverse set of expertise.   

Beyond the walls of SickKids, the campaign has been a leader on a national level through the growth of its community of practice (CoP), led by Dr. Olivia Ostrow, Associate Director of the SickKids’ Choosing Wisely program, to address overuse of tests and treatments in paediatrics across the country.  

In the last four years, despite the pandemic, the CoP has engaged more than 250 members, reaching clinicians interested in resource stewardship from most of the children’s hospitals across Canada and an increasing number in the U.S.  Campaign leaders from SickKids and members of the CoP have also collaborated on publications as well as implementation tools and resources. To date, more than 10 peer-reviewed publications have been published in impactful journals, reporting on the outcomes of the various improvement projects. 

At the same time, SickKids continues to share the principles of resource stewardship inside and outside the organization through educational forums with new trainees orienting to the hospital and through presentations at other hospitals in North America.   

The full list of the latest recommendations can be viewed below along with the previous three lists developed in 2016, 2018 and 2020. Visit the SickKids’ Choosing Wisely program page for more information.

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