Zoom Logo

Choosing Wisely Talks | Managing Scarce Hospital Resources During Omicron - Shared screen with speaker view
Jaana Ranchithan
Wendy Levinson
thanks for attending. we are eager to hear your experiences through the interactive discussion.
Julie` Herbert
We are also very short on butterflies, completely out of certain gauges, we're in ontario
Christine Soong
I’m told the global shortage of blood collection tubes is expected to last a couple of years so need a strategy to reduce unnecessary labs longterm
Amol Verma
Adele - Do you know why PT ordering increased after uncoupling?
Richard Edwards
Having discovered redundant/unnecessary tests, what are examples of specific next steps in organizations to eliminate them? Or does it require a different level policy change?
Janet Simons
“Never let a good crisis go to waste” - agree things like RBC folate and FOBT will not be missed. Like Zoom meetings, some things are here to stay (or not come back)
Kristin Hauff
I think the labs have largely tried to mitigate shortages internally, but it's really time to engage all our stakeholders in resource management.
Michael Knauer
Agree Kristen! We are trying to deal with internally and have started to reach out to share
Kristin Hauff
And I'm going to have to agree with your comment Janet! 👍
Manuel Giraldo
BUN and ESR tests are two tests that can be significantly reduced
Adina Weinerman
I agree Kristin - I think given how pervasive and ongoing these shortages will be, informing and engaging stakeholders is crucial.
Heather Holloway
Completely agree. Lab alone cannot control usage - it must come from the front-end users to increase their awareness of impact on Lab. 70% of medical decisions are based on lab tests so if Lab goes down.....
Manuel Giraldo
I joined a bit late
Manuel Giraldo
Manuel Giraldo
I don’t have camara
Manuel Giraldo
But ok
Richard Edwards
Janet's point about plastic raises the opportunity to link lab management to hospital/health system "green" initiatives.
Dr. J. Fergall Magee
We need to build a team-that includes Lab Med and frontline clinicians to develop and implement a Lab Test Formulary
Kristin Hauff
@Richard Edwards I agree, looping in @Janet Simmons' point, Never let a good crisis go to waste. A concerted effort to reduce waste is good for patients, staffing shortages, and the environment!
Joshua Buse
We utilized engagement with specific specialist groups for test restriction at the start of the pandemic to manage test utilization; ie. drugs of abuse testing requisition justifications were agreed upon with addiction doctors, ED, maternal health. We have since removed this need, but it created a reset in ordering practices and have been stable for certain tests, while others have return or exceeded pre-pandemic levels.
Karen Born
Link to study Dr. Verma is describing https://ashpublications.org/blood/article/134/Supplement_1/56/424439/Use-of-Routine-Bloodwork-on-General-Internal
Jacquie Jackson
Concern re significant restrictions to access to testing for outpatients, especially with ongoing access issues to primary care exacerbated by the pandemic
Irene Sadek
Blood loss and transfusion rates in ICU Observational Study Transfusion. 2019 Sep;59(9):2849-2856. doi: 10.1111/trf.15434. Epub 2019 Jul 8.A contemporary description of patients' estimated blood losses from diagnostic phlebotomy in a census of hospital episodes from a Canadian tertiary care centerJason G Quinn 1 2, Adrian R Levy 3, Calvino K Cheng 1 2, Steve Doucette 4, Chris Theriault 4, Don Doiron 2, Bryce A Kiberd 2 5, Karthik K Tennankore 2 5
Andrea Patey
could do Proof of Principle in the hospitals and then as Amol suggests take on the bigger iceberg as the hospitals is a closed system as Janet mentioned..
Andre Mattman
I was on a call so not sure if the point brought up yet but with virtual care being put forward as a larger percentage of care in the pandemic, the number of outpatient labs may have increased to "compensate" for lack of in person care. Have regions noticed this?
Aryn Gatto
Hi all - I think there would be some interesting options for the low hanging fruit Wendy mentioned about messaging with regards to scarcity of resources and/or specific lab tests. There are some integrations options - whether within the EMR or outside of that with integration to the EMR - that could be explored to achieve this.
Janet Simons
Pet peeve on outpatient reqs - “Aldo/renin & CBC, lytes q1month” - patient ends up getting the aldo/renin monthly - based on interpretation of unclear written instructions, not based on clinical need
Joshua Buse
In Regina, SK we have observed a return to normal outpatient order levels compared to pre-pandemic. We have not observed a significant spike in test volumes from outpatient labs that is significantly in excess of expected Year over Year increases
Michael Knauer
The Funding Model in Ontario Private Labs does not promote test utilization and the labs are not in a position to refuse a test request on the schedule of benefits.
Kristin Hauff
I think it's very good for the laboratories to hear that clinicians are interested in engaging in the appropriate utilization and resource conservation discussions. Frequently there is a thought that the lab shouldn't 'inconvenience' the clinicians. There is the other factor of how much effort we can put into building physician support tools when 'soft' techniques are shown not to be very effective long term, and 'hard stops' in the system are frustrating for users and difficult to maintain.
Adele Harrison
We focus on data and provider engagement. We have a lot of interest from medical staff in MARR https://academic.oup.com/ajcp/article/145/4/568/2195487
Karen Born
Link to NYGH-led toolkit on reducing testing in ED https://choosingwiselycanada.org/perspective/toolkit-ed-lab-testing/
Andre Mattman
Benchmarking seems like an important next step. The health region with the lowest rate of testing for a given test in the entire population (eg RBC folate), outpatient (eg NT proBNP), inpatient (eg procalcitonin), becomes the publicized/celebrated target for other Canadian labs.
Kristin Hauff
From the community and public systems, although funding doesn't directly promote utilization activities in many locations, private companies are usually better at managing waste, as they have a much better incentive. Also, the Biochemists at community labs in Canada are just as invested in patient care and appropriate utilization as those in the public evironments.
Jaana Ranchithan
Survey Link: https://www.surveymonkey.com/r/TKJ5N7J
Christine Soong
great talk, thank you all!
Jaana Ranchithan
If you have any questions following this presentation, please email us at info@choosingwiselycanada.org.
Jaana Ranchithan
Aryn Gatto
Thanks so much for this Choosing Wisely and team!
Tai Huynh
Amazing session!
Arbour Maclachlan
Amol Verma
Thank you everyone! I learned a lot!
Manuel Giraldo
Thanks Karen!
Gillian Hurwitz
Thank you so much- great discussion!
Michelle Ng
Great information! thanks!