In 2019 we told you about a doctor making a difference in the lives of patients at St. Paul’s Hospital for their work in reducing the number of daily blood draws. That was Dr. Janet Simons, Co-Medical Director, Clinical Informatics, and Internal Medicine Physician at Providence Health Care. And while we knew at the time that what she was doing was pretty incredible, she’s now been formally recognized for it as a 2022 ASCP Choosing Wisely® Champion!
First, a quick recap of Dr. Simons’ initiative.
After a chance encounter in 2018 with a patient with anemia who inquired why they continued drawing his blood when he already didn’t have enough, Dr. Simons started thinking; maybe he had a point.
“Why were we doing daily blood draws on him, knowing that likely from day-to-day, we wouldn’t see a rise or fall in hemoglobin?”
She took her question further and began looking at the pattern of routine bloodwork orders from the past two years. She found that, in many cases, orders of “Daily CBC and Electrolytes” didn’t have an end date, which meant they often continued uninterrupted for the duration of a patients’ stay at the hospital. The findings were remarkable:
- 270 patients had 30 straight days of daily bloodwork.
- 1575 patients had at least 14 straight days of daily bloodwork.
- The longest unbroken run of daily bloodwork was 202 days!
So she took action.
First, she made people aware of what was happening, then she drafted a guideline and had it approved by medical affairs and professional practice, and then on June 3, 2019 a new process was implemented. All orders to run daily bloodwork would be in place for a maximum of three days unless otherwise specified.
What does it mean to be a Choosing Wisely® Champion?
This award is presented by the American Society for Clinical Pathology (ASCP) as an initiative of the ABIM Foundation. It was first introduced in 2011 as a way to recognize the efforts of pathologists and laboratory professionals in their work to “choose wisely” about lab testing.
“As a medical biochemist, laboratory ordering is an integral aspect of my work,” says Dr. Simons. “So I’m constantly questioning, with both hospitalized patients and outpatients, ‘do we always need all of the lab tests that are ordered?'”
Per the ASCP Dr. Simons was recognized “for advancing appropriate test utilization at St. Paul’s Hospital and for demonstrating leadership of a local Choosing Wisely® effort” as her work helps to “encourage her colleagues to use the right test at the right time for the right cost.”
The award encourages physicians to keep the focus on improving patient care and reducing health care costs by avoiding unnecessary medical tests, treatments and procedures.
The impact of this initiative is wide reaching.Previously, it was often the norm at St. Paul’s Hospital to collect bloodwork from patients every morning. This can be disruptive and unpleasant for the patient and, as Dr. Simons has found, is often irrelevant to their overall care plan.
But the impact of this change doesn’t stop at improving the patient experience.
Since implementing Dr. Simons’ process, the amount of blood being collected each morning has been reduced by approximately 30 per cent. When you consider that supplies for a single collection cost two dollars, and testing for a single sample can cost five dollars, you begin to see the financial implications.
Each test requires a needle, plastic tubing, sterile collection tubes and paper labels, all of which require manufacturing and transport; the implications for environmental sustainability are substantial.
“You can imagine the environmental impact not only from the amount of waste produced, but also from planes flying across the globe to deliver supplies,” says Dr. Simons. “Decreasing the amount of blood and other lab tests is a relatively simple, yet highly impactful, means of reducing the carbon footprint of our health care system.”
Marianne Dawson, Materials Focus Area Lead with the Energy and Environmental Sustainability (EES) team agrees, sharing that “this is a great example of a change with patient benefits, cost savings and waste reduction. Clinical process change that also avoids or reduces waste means that we are lessening our negative impact on the environment and contributing to a healthier planet for everyone.”
Others are following in Dr. Simons footsteps!
At Vancouver General Hospital, Dr. Karina Spoyalo, General Surgery Resident, has been leading a team looking at how to eliminate excessive bloodwork for general surgery inpatients at the hospital. They’ve since developed recommendations to help guide lab testing in an effort to avoid unnecessary investigations. You can read more about it in the VCH Medical Staff News from earlier this year.
Congratulations Dr. Simons for helping lead the way in sustainability efforts at PHC and beyond!