Choosing Wisely at Austin Health

---

The Choosing Wisely initiative was launched in Australia just over 12 months ago and we have recently seen the second wave of recommendations announced in March. These have attracted much interest, as expected, from clinicians, the public and media. All agree that the messages that accompany the recommendations from Choosing Wisely - that it is about delivering evidence based quality care - are important in all areas of health care.

---

However, one of the challenges is to move the recommendations from paper and begin to effect change, to influence individuals, GP practices, hospital staff, and health care systems. If we are not all on the same page and have the same goals (safe, effective and efficient care for ALL patients who need it), then changing a whole system to a new paradigm becomes even more challenging than the current status.
Although we have just started the process, that will require years of work, there is much enthusiasm and, in fact, we have found, that all over the hospital, individual units are already doing much of this work. The ED already undertakes regular audits of practice, looking not only at many of the recommendations for the Choosing Wisely lists, but many more.
Our physicians have been looking at various aspects of appropriate test ordering and have seen improvements in their practice and we have a working group focusing on the important issue of End-of Life Care decisions and seeing significant changes.
Our vision is that Choosing Wisely will bring all of those groups, those champions of quality- evidence-based care, under the same umbrella so we can recognise and celebrate success and then build on the strong culture the Austin already has.
Our Choosing Wisely Committee is deliberately multidisciplinary, with support from the Hospital Executive to oversee this progress. Heads of the ED, Cardiology, Surgery, Anaesthetics and Pathology are sitting around the table. We have radiology, general medicine, nursing, medical trainees and, the most exciting part, keen medical student representation with leadership from key student educators.
So, how are we getting runs on the board?
We have presented at Grand Rounds, Heads of Unit meetings, SMS meetings and will be continuing to engage as many clinicians we can across the hospital. We will be engaging with our local GPs and, of course, source consumer groups to involve our patients and local communities in information dissemination.
The Choosing Wisely materials will be used around the hospital to provide patients and families with the recommendations for patients and the 5 questions they should ask their treating clinicians. These questions were reviewed by our Consumer Advisory Committee, who endorsed the use and distribution of them across the Health Service.
Our medical students will be a force to be reckoned with. Some have already been tasked with projects to identify areas where they can research and present their recommendations for change at future forums. We also have a study up and running exploring the barriers to change in an Australian hospital setting, so hopefully we can enlighten ourselves and many others about some of the local and system issues which need to be overcome.
And, we are getting feedback from many clinicians on investigations and treatments they have recognised across the organisation which may not be “value-adding” or lack evidence. Many of these are not on the College lists, but are obvious areas where we need to focus our efforts.
Lastly, we have started by looking at two investigations to audit and identify where we may need to improve our practice and, it is anticipated, support a change in practice. The use of coagulation studies in the hospital is one area where there may be significant over-ordering. This is on the Australasian College for Emergency Medicine list. The other, the use of plain X-ray abdominal imaging, has been a pet bug-bear of mine for some time and, unsurprisingly, I found that I am not alone. So we will be looking at that also. Choosing Wisely has inspired us to look for our own lists.
So, at Austin Health, our Choosing Wisely journey has just begun. The wheels are starting to turn and the passengers are all getting on board. We have realised that this is a long journey and will take multiple drivers to see it through. But we also know we need to balance longterm change with the need to get early runs on the board to engage and encourage a culture of Choosing Wisely across the whole organisation.
It will be a challenge, but one worth doing.
We hope that we will be able to report back on some of our progresses over the coming months… and years.
Simon Judkins
Simon Judkins is the Clinical Director Emergency Department at Austin Health, Victoria. He has been involved in Choosing Wisely from its implementation in Australia and the Australasian College for Emergency Medicine (ACEM), as one of the early supporters of the Choosing Wisely initiative.
ACEM is working closely with NPS MedicineWise to see Choosing Wisely embraced across Emergency Departments and hospitals around Australia and New Zealand. Simon is also the Chairman of the Choosing Wisely Champion Hospital initiative at Austin Health, where he is working with Clinical leaders to see the Choosing Wisely ethos embedded in one of Victoria’s busiest hospitals.

---

“At Austin Health, we made the conscious decision to become a “Choosing Wisely Champion Hospital”, a term we coined ourselves.”

---