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Resource stewardship and Choosing Wisely in a children's hospital
Jeremy N Friedman1,2, Lauren Whitney3, Melissa Jones3
1Department of Pediatrics, Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Implementing a Choosing Wisely program in a children's hospital effectively reduced unnecessary tests and treatments. Key enablers included clinician champions and leadership support, offering a model for other pediatric settings.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Resource Stewardship
Background:
- Approximately 30% of medical tests and treatments may be unnecessary, potentially causing harm.
- Resource stewardship initiatives are crucial for optimizing healthcare value and patient safety.
- The Choosing Wisely (CW) campaign aims to reduce unnecessary medical care.
Purpose of the Study:
- To describe the evolution of a hospital's Choosing Wisely program over five years.
- To highlight enablers, challenges, and lessons learned in implementing resource stewardship in pediatric healthcare.
- To inform other healthcare providers on establishing similar initiatives.
Main Methods:
- Development of "top 5" Choosing Wisely recommendations using anonymous surveys and Likert scale scoring.
- Establishment of a steering committee and outlining its composition and role.
- Implementation of measurement strategies for data, outcomes, and utilization.
Main Results:
- Significant decreases in inappropriate utilization were observed, e.g., >80% reduction in respiratory viral testing in the ED.
- Ankle radiograph use decreased from 88% to 54% for pediatric ankle injuries.
- Intravenous immunoglobulin (IVIG) use for ITP cases reduced from 88% to 55%.
Conclusions:
- An internally developed Choosing Wisely program can successfully reduce unnecessary tests and treatments in pediatric hospitals.
- Credible clinician champions, leadership support, and robust measurement are key enablers for success.
- Lessons learned are generalizable to other pediatric settings seeking to reduce unnecessary care.
Objectives:
Evidence suggests that approximately 30% of the tests and treatments currently prescribed in healthcare are potentially unnecessary, may not add value, and in some cases cause harm. We describe the evolution of our hospital's Choosing Wisely (CW) program over the first 5 years of existence, highlighting the enablers, challenges, and overall lessons learned with the goal of informing other healthcare providers about implementing resource stewardship initiatives in paediatric healthcare settings.
Methods:
We describe the development of de novo "top 5" CW lists of recommendations using anonymous surveys and Likert scale scoring. Composition and role of the steering committee, measurement of data and outcomes, and implementation strategies are outlined.
Results:
Many projects have resulted in a successful decrease in inappropriate utilization while simultaneously monitoring for unintended consequences. Examples include respiratory viral testing in the emergency department (ED) decreased by greater than 80%; ankle radiographs for children with ankle injuries decreased from 88% to 54%; and use of IVIG for treatment of typical ITP cases decreased from 88% to 55%. Early involvement focused within General Paediatrics and the ED, but later expanded to include perioperative services and paediatric subspecialties.
Conclusions:
An internally developed CW program in a children's hospital can reduce targeted areas of potentially unnecessary tests and treatments. Enablers include credible clinician champions, organizational leadership support, reliable measurement strategies, and dedicated resource stewardship education. The lessons learned may be generalizable to other paediatric healthcare settings and providers looking to introduce a similar approach to target unnecessary care in their own organizations.
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