SickKids’ Choosing Wisely program is helping reduce unnecessary testing, treatments and imaging

Hospitals and health-care providers looking to reduce unnecessary testing and procedures and improve resource stewardship at their centres could learn from the experience of The Hospital for Sick Children (SickKids).  

A recent publication in Paediatrics & Child Health describes the development of the Choosing Wisely campaign at SickKids, including the enablers and lessons learned that may be applicable in other paediatric health care settings.   

In 2016, SickKids joined the Choosing Wisely campaign, an international initiative aimed at reducing unnecessary tests, treatments and procedures, in order to increase the quality and value of care that patients receive. Now, seven years and 15 Choosing Wisely recommendations later, SickKids has demonstrated a deep commitment to addressing areas of overuse in paediatric health care and has received national recognition as a leader in the campaign.   

“At SickKids, we are not only leading the way in innovation and quality improvement in projects related to resource stewardship in paediatric hospital medicine, but we are illustrating how other organizations, large and small, can become involved in this important work too,” says Dr. Jeremy Friedman, Associate Paediatrician-in-Chief and Director of Choosing Wisely at SickKids. 

As described in the publication, the success of the campaign at SickKids is a product of the highly engaged and credible interprofessional clinician champions who lead each initiative. Other enablers include organizational leadership support, reliable measurement strategies, dedicated resource stewardship education and partnerships with patients and families. 

While the principles of Choosing Wisely have become part of the culture at SickKids, the COVID-19 pandemic, drug shortages and recent increase in children with respiratory illness have further emphasized the need for effective resource stewardship. 

Co-author Melissa Jones, a member of the Family Centered Care Advisory Council at SickKids, joined the Choosing Wisely Steering Committee in 2018. She serves with fellow family advisor and Steering Committee member Naomi Gryfe-Saperia, and together they play a pivotal and valued role in voicing the perspective of patients and their families.  

“For parents like me, the real impact of Choosing Wisely is ensuring that every poke, probe, swab, X-ray, test and follow-up is 100 per cent necessary,” says Jones. “Partnering with patients and families means that we’re able to colour data-driven work with real stories about the impact for kids in the hospital and make the work of our resource stewardship even more meaningful.” 

While the framework for the campaign at SickKids is a single-site example, Friedman and other leads, including Dr. Olivia Ostrow, Director of Quality & Safety, Paediatric Emergency Medicine and Associate Director of the Choosing Wisely Program, and Lauren Whitney, Program Manager, hope that many of the principles detailed in the publication can be applied at other centres pursuing Choosing Wisely activities. 

“In the backdrop of our incredibly overburdened paediatric health-care system, the importance of resource stewardship and Choosing Wisely as an enabler of related initiatives is even more essential today than ever before,” says Friedman.

How SickKids is Choosing Wisely

• Since 2016, SickKids has introduced three Choosing Wisely lists totalling 15 recommendations. Initial recommendations focused primarily on Paediatric Medicine and the Emergency Department. The campaign has since expanded its reach to include General Surgery as well as Anaesthesia and Pain Medicine. Collaborations have promoted antimicrobial stewardship projects with recommendations led by Pharmacy and Infectious Disease champions.  
• SickKids became the first paediatric hospital to be designated as a Level III Choosing Wisely hospital.       
• In collaboration with Choosing Wisely Canada, SickKids developed an evidence-based and easy to follow toolkit – “Say Nay to the X-ray” – which includes tools and methods to reduce unnecessary low-risk ankle imaging at paediatric emergency departments. The toolkit is available publicly to support quality improvement and decrease unnecessary tests and treatments in paediatric health-care settings. 
• At a national level, SickKids launched a community of practice to foster knowledge sharing and collaborative learning and promote high-quality, value-added care by focusing on overutilization of certain tests and therapies. The community of practice, with the support of Choosing Wisely Canada and Children’s Healthcare Canada, has since hosted nine webinars and has engaged a diverse audience from paediatric acute care centres and community sites coast to coast.
• Clinicians and organizations interested in learning more about adopting Choosing Wisely principles or specific initiatives that have been successful at SickKids can visit Children’s Healthcare Canada for more information.