A group of clinical staff are leading Waikato DHB’s campaign to reduce tests, treatment and procedures that are unnecessary, duplicating what has already been done, or potentially could cause more harm than good to a patient.
A national Choosing Wisely campaign was launched today as a joint initiative between the the Council of Medical Colleges and the Health Quality & Safety Commission, Ministry of Health and Consumer NZ (see news release here).
However Choosing Wisely at Waikato DHB kicked off earlier this year with an awareness campaign for clinical staff to encourage more thought about routinely ordered tests which may be unnecessary.
“We wanted to get started, so we formed a group of interested senior clinicians, pathology and laboratory staff and got an initiative underway that worked in with what was happening internationally and nationally,” says Dr Paul Reeve. “It’s good to see a national campaign and website launched now which will really help spread the word.”
The results are already showing a positive impact with the number of urine tests processed by the Waikato Hospital Laboratory, for example, down 20 percent for the July to September quarter compared to the previous quarter.
Low cost/high volume tests such as urine tests can end up using considerable hospital resource without adding anything to a diagnosis. “Earlier this year we estimated more than half the urine samples sent for testing were not clinically necessary. Some urine tests are important, but many others are not. It takes up resources which could be better used elsewhere in the hospital, and it puts patients through a process and a delay that doesn’t add any benefit.”
Laboratory manager Kay Stockman agrees. “It’s not about cutting costs, but using our clinical and laboratory resources where they are most effective for best patient care.
“We are reminding clinical staff it is wise to stop, think and if necessary discuss or check before they order a test or procedure they are not sure is necessary.”
Reeve adds that there is plenty of evidence to support a decision to order a test or not. “Often it comes down to giving medical and nursing staff information about that evidence and the confidence to question what is just common practice or routine.”
The four checks recommended are:
- Is the decision is supported by evidence?
- Is it duplicating something already done?
- Is it truly necessary?
- Is it free from potential harm to the patient that outweighs any real benefit?
“We’ve used our clinical forums, an awareness campaign and promotion of local clinical guidelines to give clinical staff the confidence to question and check before ordering a test or procedure or embarking on treatment which might be wasteful and have little or no benefit,” he says
Choosing Wisely is an international movement. It is supported by many health sector groups. Similar campaigns are run in Australia, Canada, England and several other countries.
The Waikato group includes senior clinicians Dr Paul Reeve and Dr John Bonning, Laboratory manager Kay Stockman and Pathology clinical director Stephan du Toit, and is supported by chief nursing and midwifery officer Sue Hayward and associate director of nursing Kate Yeo. The group is sponsored by Community and Clinical Support executive director Mark Spittal.
Images on this page from the Waikato DHB Choosing Wisely campaign for engaging clinical staff in questioning whether a test or procedure is really adding value to diagnosis and patient care. The campaign uses 1960s comic book style, and were illustrated Scott Pearson of Visual Evolution, Hamilton. Copyright Waikato DHB.