Implementation

This toolkit has been specifically developed to help Junior Medical Officers (JMOs) and students with implementing projects aligned with Choosing Wisely principles. It contains support material to help guide each stage of a Choosing Wisely project.

Fertility treatment, including IVF, can take months or even years, and it doesn’t always work. It can be difficult for people to make decisions about which tests, treatments and add-ons will improve the chance of a baby. There are many options available that have little or no evidence to support them. The Victorian Assisted Reproductive Treatment Authority (VARTA) has adopted Choosing Wisely’s 5 Questions to help people make informed choices about the most effective treatments.

In July 2021, during the COVID-19 response at the Wollongong Hospital A5 ward, we noted pathology testing for COVID-19 patients was far greater than the average patient, and unnecessary in many cases. A Choosing Wisely program of guideline development, education and support saw an 81% reduction in tests ordered, increasing patient safety and comfort with no adverse impact on patient care.

Darling Downs Health used the Choosing Wisely 5 Questions to help their rural patients ask questions of their healthcare teams, however, feedback made it clear that local doctors wanted support to help respond. The program was broadened to include medical staff and a printable resource was created to support health professionals have these discussions with their patients. Early evidence suggests this has led to an even stronger program with increased benefits for both patients and doctors.

An audit at the Sunshine Coast University Hospital found that 41% of all pre-operative pathology tests ordered before elective surgery were unnecessary. A Choosing Wisely program introduced at the hospital to address this issue started with urology procedures, and has seen significant improvements.

In the Intensive Care Unit, blood tests and chest radiographs are usually requested on a routine, time-scheduled basis, and many may be unnecessary. The Fiona Stanley Hospital in Perth has developed a replacement protocol to reduce unnecessary tests and will evaluate and optimise this protocol in a large clinical study.

Chronic wounds represent a significant burden to patients and the healthcare system, and can result in significant functional impairment, reduction in quality of life and large financial costs (around 2% of total health expenditure in Australia). The Choosing Wound Care Wisely project from Mackay Hospital and Health Service (Mackay HHS) in Queensland is about ensuring wound treatment is appropriate to the cause and condition of a wound, maximising clinical effectiveness, reducing patient risk, minimising cost and facilitating patient choice where possible.

Blood tests ordered that do not provide information that change treatment or patient outcomes are unnecessary, bring inconvenience for patients, increase medical staff workload, and add extra costs. As part of their Choosing Wisely work, Shellharbour Hospital has introduced an education program to support junior medical officers (JMOs) choosing blood tests wisely.

Blood cultures are used to detect blood stream bacterial infections and are essential to tailor antibiotic therapy. However, repeated blood cultures for a patient who is stable, has already had blood cultures taken and antibiotics started, are unlikely to change treatment or diagnosis. Therefore, to reduce waste, and patient discomfort, take blood cultures wisely.

Opioids continue to be the primary drug associated with drug-related deaths in Australia with prescription opioids constituting the majority of unintentional deaths due to opioids since 2004. The Sunshine Coast Hospital and Health Service has applied a Choosing Wisely approach in the Emergency Department to address the problem.

The COVID-19 pandemic has demanded new, integrated and innovative approaches to the way healthcare is delivered. Telehealth options have been part of the solution to ensure patients continue to access the care they need in a timely, safe and convenient way. For some areas of medicine, patients may have reservations about if they will get the same level of care. Empowering health consumers to continue to ask questions in the virtual environment is important to ensure they get the right healthcare for them.

The Prince Charles Hospital in Chermside, Queensland is one of the newest Choosing Wisely Champion Health Services. Jessica Toleman, Senior Director of Clinical Operations tells the story of embedding Choosing Wisely into the organisation during COVID-19, making Choosing Wisely ‘the way we do things around here’.

The PROV-ED (PROmoting Value-based care in EDs) project disseminates value-based emergency department (ED) initiatives to public hospital clinicians using display monitors in clinical areas of EDs across Queensland.

Debra Letica never expected to become a carer during her lifetime, but it was the most natural thing to do. She now uses and promotes Choosing Wisely personally and as a consumer advocate in the health system.

With the prescribing rates of opioids in Australia continuing to rise, the team from the Sir Charles Gairdner Hospital (SCGH) in Western Australia have developed a new guideline and discharge form to support best-practice Choosing Wisely principles in opioid prescribing.

A slide deck for Choosing Wisely Australia advocates who are presenting on the initiative at meetings or events.

Sunshine Coast Hospital and Health Service (SCHHS) recognises that for many people hospital is just one part of their healthcare journey, so helping consumers ask questions about their care and promoting broader collaboration with consumers is vital.

As part of Choosing Wisely Australia’s clinical educational activities, members are being encouraged to develop case studies that demonstrate the application of specific recommendations for use in their usual teaching modules.