Bloodwork at KHSC lab

Kingston Health Sciences Centre (KHSC) has joined a growing list of hospitals across Canada, recently receiving a Level 1 Hospital Designation from Choosing Wisely Canada.

The Choosing Wisely Canada (CWC) program is focused upon ensuring appropriateness of tests and treatments for patients and improving the use of health care resources, thereby resulting in safer and higher quality care. KHSC is now one of just 38 hospitals across the country to receive this official designation.

“It was our goal to earn this designation as a testimony to the safe and high quality patient care offered at KHSC, and to showcase our stewardship of health care resources in relation to ordering of lab tests, blood products and medical imaging tests,” says Dr. Michael Fitzpatrick, KHSC’s Chief of Staff. “Achieving this level 1 designation is a tribute to the excellent leadership and hard work by Dr. Sandip SenGupta, Dr. Johanna Murphy and their colleagues on the Utilization Committee at KHSC. We are very proud of this achievement, which took less than a year to accomplish, and we look forward to the continuation of our journey towards CWC designation.”

According to Choosing Wisely Canada, unnecessary testing and treatment is a pervasive problem in health care and is present in virtually every hospital, department and clinic, irrespective of size or how diligent the clinicians are who work there. In fact, a 2017 report from the Canadian Institute for Health Information and Choosing Wisely Canada showed that in many clinical areas, up to 30 per cent of tests and treatments are probably unnecessary.

“Our Utilization Committee worked together as a multidisciplinary team and created five working groups to address each of the five Level 1 requirements. There was a tremendous amount of work done by each of the working groups to achieve this designation,” says Dr. Sandip Sengupta, Medical Director of KHSC’s Clinical Labs. “This is an important stepping stone that will provide momentum for KHSC to strive towards quality improvement and leadership goals in utilization management which will be needed for full certification.”

Specifically KHSC’s efforts focused on making improvements in five key areas involving our Clinical Laboratories and Diagnostic Imaging services. These included:

  • uncoupling PT/INR and aPTT tests and revising order panels in the Emergency Department,
  • eliminating CK testing if troponin is available,
  • removing “daily lab” options from order sets,
  • removing folate testing from hospital ordering systems, and
  • stopping ordering routine chest X-rays in the ICU except to answer specific clinical questions.

“While CK-MB is a biomarker of cardiac damage, it has been replaced by troponin in the routine diagnosis of acute coronary syndrome. The removal of CK-MB as an orderable test ensures that patients are appropriately diagnosed,” says Dr. Curtis Oleschuk, who led the CK testing working group. “The right test, at the right time, for the right reasons, ensures we efficiently use health care resources and minimize the risk to the patient with medical interventions.”

“KHSC’s success in achieving Choosing Wisely Canada level 1 designation highlights how far we have come as an institution in advancing patient safety and health quality,” says Dr. Geneviève Digby, Chair of the Physician Quality Committee. “These efforts are an inspiration to all of us working towards advancing the quality agenda and I look forward to seeing how much we can accomplish together.”

Moving forward, KHSC will aim to implement further Choosing Wisely Canada recommendations to move to Level 2 and eventually Level 3 designations.

“We are incredibly proud of our teams who were able to achieve this designation for KHSC,” says Dr. Fitzpatrick. “This work will not only ensure that we are using health-care resources wisely but, at the end of the day, that we are also providing the most appropriate care for patients in our community.”

To learn more about Choosing Widely Canada, you can visit their website at: https://choosingwiselycanada.org/