The MUHC, proud recipient of Level 1 designation from Choosing Wisely Canada

The MUHC is the first hospital in Quebec – and one of the five in Canada – to receive Level 1 designation

Choosing Wisely CanadaFollowing a successful evaluation by Accreditation Canada, the MUHC has yet another good reason to celebrate and to keep up the good work. The MUHC is a designated Level 1 Choosing Wisely Canada hospital since May 29, taking the first step in the recognition of its commitment towards reducing overuse of tests and treatments for the benefit of patients. It is the first hospital in Quebec – and one of the five in Canada – to receive Level 1 designation.

“This is a first step, but this is an important one,” says Dr. Carolyn Freeman, Chair of the MUHC Clinical pertinence coordinating committee (CPCC), which was created in March, 2018. “This is a milestone.”

Part of a global movement that was created in the United States five years ago, Choosing Wisely Canada (CWC) is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices through the use of a list of “Things Clinicians and Patients Should Question.” These lists contain recommendations of tests, treatments, and procedures to be used less or stopped altogether since they are not backed by evidence and could potentially expose patients to harm. To date, over 300 recommendations have been published.

The MUHC started with five quick wins in Level 1, five basic but important recommendations regarding the use of certain tests.

“In fact, these were well implemented already,” says Dr. Freeman. “It was a matter of documenting it to get the designation.”

“The MUHC has a long-standing commitment to high-quality and high-value care, so we were excited when this opportunity presented itself,” says Dr. Emily G. McDonald, assistant professor of medicine and member of the CPCC executive committee. “Many of the quick wins are established practice in our institution. Receiving the CWC designation is a well-deserved recognition for the quality care that the MUHC provides.”

Achieving Level 2 implies implementing three additional recommendations, while Level 3 is granted to organizations who lead by reducing overuse and promoting culture change (see table Choosing Wisely Canada designation levels).

“We believe the MUHC has all that it takes to achieve Level 3, and we are aiming to get the designation this year,” says Dr. Sebastian Negrete, assistant professor, Department of family medicine and member of the CPCC. “The efforts are made, the committees are working, and the administration strongly supports the initiative.”

 

Table: Choosing Wisely Canada designation levels

  SCOPE OF CHANGE ACTIONS
LEVEL  1 Implement the 5 "quick wins"
  • Uncouple PT/INR and aPTT tests and revise ED order panels
  • Eliminate CK testing if troponin is available
  • Remove "daily lab" options from order sets
  • Remove folate testing from your hospital's ordering systems
  • Stop ordering routine chest X-rays in the ICU, except to answer specific clinical questions

*Note: if these actions are not relevant to your hospital, please substitute.

LEVEL 2 Implement an additionnal 3 Choosing Wisely Canada recommendations through quality improvement methods
  • Quality improvement methods must include collection of baseline data, the intervention(s), and collection of results data
  • Projects could include implementation of Choosing Wisely Canada toolkits
LEVEL 3 Take organization-wide leadership on overuse and promote culture change
  • Make Choosing Wisely part of the hospital's operating/strategic plan
  • Implement at least 10 distinct Choosing Wisely Canada recommendations, across multiple hospital departments. The recommendations implemented in Levels 1 and 2 may count towards 10. 
  • Mentor or collaborate with at least 1 other hospital on Choosing Wisely