Choosing Wisely in action in DHBs
The Choosing Wisely campaign is in place in many district health boards, and is soon to be introduced by others. This month we are featuring Canterbury DHB which has a number of Choosing Wisely projects, and has found that supporting doctors to question the necessity of a particular test, treatment or procedure has been key to implementing a Choosing Wisely approach across many services.
‘In terms of establishing Choosing Wisely projects, we’ve been quite doctor-focused on the basis that doctors are making most of the decisions about ordering investigations and tests,’ says the DHB’s Service Improvement Lead, Carol Limber, who has responsibility for Choosing Wisely implementation.
‘Doctors can be under pressure to do tests and investigations – partly to make sure they don’t miss something – but also because of patient expectations.’
Ms Limber says implementing Choosing Wisely has had a focus on radiology testing, but it has not been limited to this. The Choosing Wisely programme also has projects looking at blood tests, prescribed medications and pathways for follow up and surveillance. A recent area of focus in the Choosing Wisely campaign is perioperative care and pre-surgery assessments. ‘We’re looking at the concept of routine chest x-rays, urinalysis, ECGs and blood tests. For example, if the patient is under 70 years old and has no previous history of a cardio pulmonary disorder, do they need a chest x-ray? We’re asking people to think about the patient’s risk factors, the surgery risk factors and what investigations are needed for that patient, rather than have a blanket approach of tests that we do on everyone.
‘We’re really mindful that this is about doing the right thing and balancing risk for the patient. Undoubtedly, if we reduce the amount of unnecessary and duplicate testing, there will be a system benefit, but that’s not our starting point. ‘In some areas we might be under investigating, or doing the wrong test, or not doing the most appropriate test, so it’s about making sure we’re doing the right test at the right time for that patient.’