SickKids launches third phase of Choosing Wisely recommendations to curb unnecessary tests and treatments

Building on our Choosing Wisely successes over the past year, The Hospital for Sick Children (SickKids) is launching a third list of recommendations (PDF) to address the potential overuse of tests and treatments received by patients at the hospital. 

In 2016, SickKids joined the Choosing Wisely campaign, an international initiative to question unnecessary care that is embedded in our SickKids 2025 strategic plan. Only three years later, SickKids became the second hospital and first paediatric institution in Canada to earn a Level 3 designation from Choosing Wisely Canada - the highest achievement a hospital can attain and only awarded to those that implemented at least 10 Choosing Wisely recommendations and demonstrated a deep commitment through organizational leadership, culture change and mentorship. 

A number of successful reductions in unnecessary care have been realized since the publication of the second list in 2018, which has a notable focus on antimicrobial stewardship. One recommendation in particular has led to the reduction of urinary tract infection misdiagnoses in SickKids’ Emergency Department patients by over 25 per cent, resulting in decreased unnecessary antibiotic use.

"I am deeply proud of our staff of clinicians and trainees for embracing and supporting these important Choosing Wisely initiatives," says Dr. Jeremy Friedman, Associate Paediatrician-in-Chief and leader of the Choosing Wisely program at SickKids. "Any number of tests and treatments in health care that do not add value and at the same time could cause discomfort or harm to patients is too high. This list of five new recommendations will keep our momentum going and further improve the quality and safety of the care we provide."

The new list was created through extensive consultation with a diverse group of SickKids stakeholders, including representatives from SickKids’ Family Advisory Network; divisions and departments including Diagnostic Imaging, Paediatric Laboratory Medicine, Pharmacy, Paediatrics, surgical care units as well as the Utilization Management and Antimicrobial Stewardship Committees.

Friedman noted that the COVID-19 pandemic has merely magnified the importance of resource stewardship, which is about providing care to patients based on evidence it’s the right care at the right time for the right patient. "With pandemic restrictions leading to longer waiting lists for services, the principles underlining resource stewardship are key to avoiding unnecessary care to make way for care that is truly needed," he adds.

The Choosing Wisely program at SickKids also has a role to play beyond the hospital walls through the ongoing development of a national community of practice to engage clinicians in paediatric centres across Canada. SickKids has partnered with Children’s Healthcare Canada to create a hub to facilitate this national cooperation. At the same time, SickKids continues to share the principles of resource stewardship through teaching sessions to all levels of trainees as well as Continuing Medical Education events provincially and nationally.

The 2020 list of recommendations can be viewed below along with the previous two lists developed in 2016 and 2018. Learn more about the Choosing Wisely program.