March 5, 2020
The Choosing Wisely Canada Level 3 Designation certificate was presented at LHSC’s Senior Leadership Council on March 4. Pictured from left to right: Tim Rice, Director, Medicine (Victoria Hospital); Mike Kadour, Director, Pathology & Laboratory Medicine; Dr. Ian Chin-Yee, Hematologist and co-applicant for designation; Dr. Mayur Brahmania, Transplant Hepatologist and co-applicant for designation; and Dr. Adam Dukelow, Chief Medical Officer.
LHSC has received a Level 3 designation by Choosing Wisely Canada (CWC). This is the highest designation awarded by CWC to a hospital in recognition of implementing 10 CWC recommendations and an organization-wide commitment to reducing overuse. The prevalence of unnecessary tests, treatments and procedures in Canada is approximately 30 per cent according to CWC. By reducing this overuse, hospitals can improve quality, safety and realign resources to provide greater value for patients.
For Dr. Mayur Brahmania, a transplant hepatologist at London Health Sciences Centre (LHSC), the importance of evidence-based quality improvement initiatives, such as those promoted by CWC are the future of health care. “Medicine has evolved over the years and we are really at a turning point in how we deliver care to our patients,” says Dr. Brahmania.
Dr. Brahmania was first introduced to Choosing Wisely Canada (CWC) a few years ago as part of his work with the Canadian Association for the Study of the Liver. He was given the opportunity to lead the Top 5 Recommendations for Hepatology and then participated on the CWC committee that helps hospitals be designated. He brought his experience back to LHSC and began working with Dr. Ian Chin-Yee, a hematologist at LHSC on obtaining a Choosing Wisely Canada Hospital designation.
Dr. Chin-Yee has also witnessed a shift in the provision of health care during his career. “Over the years, I’ve started seeing less value added to patient care. I recognized the old approach of ordering tests was not sustainable. Choosing Wisely encourages health-care professionals to reduce interventions, therapies and tests that offer low value.”
The implementation of CWC initiatives began as Dr. Chin-Yee says “primarily from the laboratory taking initiative to improve utilization about four years ago. As the momentum picked up we identified multiple misused or over utilized tests.” The momentum keeps building as the CWC philosophy of improving quality and safety by engaging front-line staff aligns with other continuous improvement initiatives currently underway at LHSC.
The application for Level 3 designation, led by Dr. Brahmania and Dr. Chin-Yee required compiling information on the various CWC initiatives underway at LHSC. This included the implementation of 10 recommendations across four departments including Emergency, Medicine, Pathology and Laboratory Medicine, and Surgery. Some of the recommendations implemented at LHSC include removing folic acid testing from standard blood tests; reducing the number of unnecessary chest x-rays for critically ill patients; and reducing repetitive blood tests for patients that are stable. These changes have taken place to improve the quality of care, and reduce risk and harm to patients.
The other two requirements for the Level 3 designation are to support CWC initiatives in the organization’s Strategic Plan and to mentor another hospital in implementing CWC recommendations. LHSC accomplished both these tasks with the 2018-2020 Strategic Plan: Working Together to Shape the Future of Health and by mentoring Middlesex Hospital Alliance.
For Dr. Chin-Yee, it was important to obtain the highest designation level from the outset because he feels that “as an academic centre we should be leaders of change.” Dr. Brahmania agrees and encourages everyone at LHSC to become a leader of change by participating in continuous improvement initiatives. As a CWC hospital with a level 3 designation, LHSC is working together with staff, physicians and partners to shape the future of health.