https://choosingwiselycanada.org/events/past/

thanks for attending. we are eager to hear your experiences through the interactive discussion.

We are also very short on butterflies, completely out of certain gauges, we're in ontario

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

Adele - Do you know why PT ordering increased after uncoupling?

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?

“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)

I think the labs have largely tried to mitigate shortages internally, but it's really time to engage all our stakeholders in resource management.

Agree Kristen! We are trying to deal with internally and have started to reach out to share

And I'm going to have to agree with your comment Janet! 👍

BUN and ESR tests are two tests that can be significantly reduced

I agree Kristin - I think given how pervasive and ongoing these shortages will be, informing and engaging stakeholders is crucial.

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.....

I joined a bit late

Sorry

I don’t have camara

But ok

Janet's point about plastic raises the opportunity to link lab management to hospital/health system "green" initiatives.

We need to build a team-that includes Lab Med and frontline clinicians to develop and implement a Lab Test Formulary

@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!

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.

Link to study Dr. Verma is describing https://ashpublications.org/blood/article/134/Supplement_1/56/424439/Use-of-Routine-Bloodwork-on-General-Internal

Concern re significant restrictions to access to testing for outpatients, especially with ongoing access issues to primary care exacerbated by the pandemic

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

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..

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?

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.

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

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

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.

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.

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

Link to NYGH-led toolkit on reducing testing in ED https://choosingwiselycanada.org/perspective/toolkit-ed-lab-testing/

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.

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.

Survey Link: https://www.surveymonkey.com/r/TKJ5N7J

great talk, thank you all!

If you have any questions following this presentation, please email us at info@choosingwiselycanada.org.

https://choosingwiselycanada.org/perspective/abstracts-2022/

Thanks so much for this Choosing Wisely and team!

Amazing session!

Thanks

Thank you everyone! I learned a lot!

Thanks Karen!

Thank you so much- great discussion!

Great information! thanks!