Promoting Choosing Wisely recommendations in QLD Emergency Departments

Providing targeted but widespread education and information to public hospital clinicians can be difficult, given the unrelenting stream of emails and multitude of posters in corridors. Emergency departments (EDs) are particularly challenging environments, due to the diversity of care provided and the often fast-paced nature of the work. Clinicians on the floor rarely have time to trawl through emails to extract pertinent information and posters soon become ‘part of the furniture’. Global recognition of the need to practice value-based healthcare, particularly reducing low-value care, has made it more important than ever to ensure that messaging reaches the coal face - where frontline clinicians who can affect change. An approach encouraging a shared vision of responsible resource custodianship to contribute to sustainability of the health system is welcomed by clinicians and policy-makers.

The PROV-ED Project team utilised a method to support sustainable change, embarking on the ambitious task of installing display monitors in clinical areas of EDs across Queensland. In conjunction with navigating the steps required to procure and install 23 flat screen monitors, the team set about developing a suite of visually appealing, simple slides to communicate meaningful information. The initial slides were created in collaboration with a graphic designer and targeted the six PROV-ED Project value-based care initiatives. These initiatives had been showcased on an opt-in basis to EDs across Queensland, with very strong uptake across the board. Experience of the team on previous state-wide projects suggested that an ability to present regular feedback of local outcome data to staff at all levels was beneficial to clinician engagement and effective implementation. This was a large part of the motivation to use the screens, however it wasn’t long before the team realised there was an opportunity to capitalise on this direct access to clinical staff by broadening the scope of the messaging presented.

The PROV-ED Project aligns very strongly with the ethos behind Choosing Wisely, and the opportunity to promote the six ACEM Choosing Wisely Recommendations seemed like an obvious step.

With project budget limiting further professional graphic design input, the team used an online design tool to create new slides based on the existing templates. They also decided to include some general wellness and mindfulness messaging to avoid sensory overload and attempted to sparingly integrate humour or quirkiness as a means of engaging clinicians and starting conversations. The onset of COVID-19 also presented a need to promote further relevant clinical and wellness messaging.

No firm data around the effectiveness of the screens have been collected, but anecdotal feedback is indicating they are being very well received. The suite of slides is now extensive, and the team ensures slideshows are updated regularly at each site to ensure ongoing interest.

For more information on the PROV-ED Project and the six value-based care initiatives being promoted see the Clinical Excellence QLD Improvement Exchange at

https://clinicalexcellence.qld.gov.au/improvement-exchange/prov-ed

Australasian College for Emergency Medicine (ACEM) Choosing Wisely recommendations

PROV-ED videos to promote ACEM Choosing Wisely Recommendations