Recommendations and Resources

Up to 30% of tests, treatments, and procedures in Canada are potentially unnecessary.

Unnecessary tests, treatments, and procedures

• do not add value for patients
• potentially expose patients to harm
• lead to more testing to investigate false positives
• contribute to unwarranted stress for patients and their families
• consume precious time and resources.

For example, Canadian and international guidelines note that seniors should not be on long-term prescriptions of benzodiazepines (sleeping pills). These powerful drugs can increase their risks for car accidents, falls, and hip fractures. Yet, the Canadian Institute for Health Information (2017) revealed that the rate of long-term benzodiazepine use among seniors ranged from 5% in Saskatchewan to 25% in New Brunswick. [can we replace this with a peds example?]

So why do these unnecessary activities occur? Well, there are many possible drivers of unnecessary tests, treatments, and procedures, including:

• Practice habits are traditionally difficult to change, even in the face of new evidence
• Patients might request tests and treatments without having all the information about the risks and benefits
• Lack of time for shared decision-making between clinicians and patients
• Outdated decision-support systems encourage over-ordering
• Defensive medicine and fear of malpractice lawsuits drive over-investigations
• Payment systems reward doing more

To learn more visit Choosing Wisely Canada or view all Choosing Wisely Canada Recommendations (by specialty).

Paediatric Emergency Medicine (2022)

SickKids Choosing Wisely (2020)

Choosing Wisely Canada mobilizes and supports clinicians and organizations committed to embedding campaign recommendations into practice. With their support, SickKids developed an evidence-based and easy to follow toolkit – “Say Nay to the X-Ray” – which includes tools and methods to reduce unnecessary low-risk ankle imaging at paediatric emergency departments. The toolkit is available publicly to support quality improvement and decrease unnecessary tests and treatments in paediatric health care settings.

4 Questions to Ask your Health-Care Provider About Antibiotics (2022)

Quatre questions à poser à votre fournisseur de soins de santé concernant les antibiotiques (FR- 2022)

Say Nay to the X-Ray Toolkit (2021)

Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care (Pediatrics 2022)

Choosing the future of paediatrics wisely (Healthy Debate 2021)

Routine T4 No More? Reducing Excess Thyroid Hormone Testing at a Pediatric Tertiary Care Hospital (J Peds 2021)

Improving Healthcare Value: Reducing overuse in hospital pediatrics (J Hosp Med 2021)

Avoid doing chest x rays in infants with typical bronchiolitis (BMJ 2021)

Using antibiotics wisely for respiratory tract infection in the era of COVID-19 (BMJ 2020)

Engaging medical trainees in resource stewardship through resident-led teaching sessions: A Choosing Wisely educational initiative (CMEJ 2020) *recognized as a CMEJ article of the decade

Saline-Lock Versus Continuous Infusion: Maintaining peripheral intravenous catheter access in children (Hospital Pediatrics 2020)

Saying Yes to the Less: Making it easier to Choose Wisely (J Peds 2018)

Antibiotics overuse can have harmful side-effects (Toronto Star 2017)