Choosing Wisely hospital concept extended across Victoria

A Choosing Wisely champion hospital pilot in Victoria has been so successful the initiative is being extended to 11 other hospitals in the state.

Asmara Jammali-Blasi is leading the implementation of Choosing Wisely across Victoria as part of the Safer Care Victoria Choosing Wisely Victorian Collaboration. She presented on the collaboration to over 100 participants at the Choosing Wisely forum in Wellington today.

The Choosing Wisely campaign encourages health professionals to question current practice and discuss the potential risks and benefits of undergoing tests, treatments and procedures with consumers. Consumers are encouraged to ask health professionals whether they really need a particular intervention.

In 2016, Austin Health in Heidelberg Victoria was supported by the Better Care Victoria Innovation Fund to become a Choosing Wisely champion hospital. The hospital sought to create a culture of always questioning whether a test, treatment or procedure was needed, thereby reducing the number of these interventions.

'The message is always question, always think, always use an evidence base for your patients so they receive the best care,' Ms Jammali-Blasi says. 'It’s also important to talk to patients about what they want and need, not just what we think is best. It's a significant change in culture, but a change which needs to happen.'

The Choosing Wisely initiative at Austin Health demonstrated statistically significant reductions in the volumes of unnecessary coagulation studies and urine cultures being ordered. Auditing of test indications supported this finding and highlighted that clinicians are ordering in line with clinical recommendations. Pilot projects in other hospitals in Australia also showed a reduction in unnecessary testing.

A collaboration project was subsequently designed in Victoria, funded by the Better Care Victoria Innovation Fund to enable another 11 hospitals across the state to become Choosing Wisely hospitals. Through a supported learning environment, these health services go through the process together using the methodology and structure developed by Austin Health.

'The aim of the collaboration is to increase the number of health services across Victoria that support health professionals in delivering safe, effective and efficient care for patients. That means reducing unnecessary tests, treatments and procedures,' Ms Jammali-Blasi says.

Her presentation at the New Zealand Choosing Wisely forum looked back on the past 12 months, including how sites’ eligibility to participate in the project was assessed, the resources sites were provided with, and evaluation of the project.

'There were visits to participating sites over the course of the project, and regular workshops to provide resources and the opportunity to share learnings, as well as reporting.

'The collaboration project is being independently evaluated, with formative, process and summative evaluation. Because the project is in its final stage we don’t yet have any results in terms of reduced volumes of testing. However, we do have some qualitative data looking at things like how useful participants found the group workshops, resources and standardised tools; and what people would have liked done differently.'

She says the main learning to date has been that there is no ‘one-size-fits-all’ approach.

'There are so many variables, particularly in Victoria. We had one hospital participating that had an ED with 12 beds, and another with 80 beds. Our approach was that no matter what type of hospital you were, you were eligible to be part of the collaboration as long as you had executive support and were ready for Choosing Wisely change to be made.'

She says lessons learnt included:

• the need for early engagement of project managers for discrete funding periods
• having project management tools for clinicians less experienced in project management
• taking your time in the planning stage: Consider not only what the problem is but why it is happening
• factoring in the time it takes to set up evaluation measures
• rewarding success and taking unintended short comings as learning opportunities.

Full evaluation results from the Victorian Choosing Wisely Scaling Collaboration are expected later in the year.

About Choosing Wisely

The Choosing Wisely campaign has considerable momentum in New Zealand. Seventeen district health boards are involved in Choosing Wisely work and it is supported by a number of PHOs and GP practices. Thirty-one medical colleges, specialty societies and health practitioners’ associations are now linked to the campaign. Over 154 lists of tests, treatments and procedures that should be questioned have been developed, along with 45 patient resources.