Doing Less, Achieving Better: Lessons from Choosing Wisely in Manitoba

For over a decade, Manitoba has been an adopter of Choosing Wisely, leading and sustaining change through a variety of initiatives. In this panel keynote, experts will share successes, challenges, and lessons learned in shifting the culture towards « doing less » to achieve better health outcomes.

– Dr. Eric Bohm, Orthopaedic Surgeon and Professor of Surgery, University of Manitoba
– Christine Peters, Director, Health Services, Shared Health
– Dr. Alex Singer, Family Physician and Associate Professor, University of Manitoba
– Dr. Abdulrazaq Sokoro, Chief Operating Officer, Provincial Diagnostic Services, Shared Health

Learning Objectives:

• Identify the impact of low-value testing on health care systems and patient outcomes.
• Describe successful strategies for implementing change at both the individual and system levels.
• Discuss opportunities to sustain change in health systems.

Learn how to tackle overuse in your practice through workshop sessions and abstract presentations featuring innovative approaches from across the country. Participants can select one of the following sessions to attend.

Tackling Low-Value Lab Testing in Canada | Room 4

Low-value lab testing has been a longstanding problem in Canada, straining hospital resources and potentially exposing patients to unwarranted investigations and treatments. This session will explore strategies to drive change and evaluate lab utilization, both at the frontline and system levels.

Dr. Thomas Bodley, Clinician Co-Lead, Using Labs Wisely, Choosing Wisely Canada

Learning Objectives:

• Summarize ways to reduce lab overuse in hospitals or health systems.
• Describe examples of how implementation efforts have led to reductions in unnecessary lab testing.
• Discuss evaluation efforts within the Using Labs Wisely program.

Mobilizing the Next Generation to Choose Wisely | Room 7/8

Facilitated by Dr. William Silverstein, this session will showcase medical student leaders and their innovative approaches to engage learners in resource stewardship.

Div Patel and Nathan Jeffrey, Medical Students, Northern Ontario School of Medicine University
Julia Pei and Charuta Saha, Medical Students, University of British Columbia
Carolyn Campbell, Medical Student, University of Calgary
Josh Collins and Jakalee Myette, Medical Students, Dalhousie University
Dr. William Silverstein, STARS Lead, Choosing Wisely Canada

Learning Objectives:

• Recognize the importance of resource stewardship competencies in medical education.
• Describe how to leverage medical student leadership in implementing Choosing Wisely initiatives.
• Show examples of successful medical student leadership from across the country to advance resource stewardship initiatives.

Patient Engagement: Lessons From a De-Implementation Study | Room 5

This session will offer lessons learned and best practices from a multi-year de-implementation study, highlighting effective strategies for meaningful patient engagement. The resources and ‘how-to’ examples featured in this session are not limited to research, but useful to anyone working with patients and the public in their de-implementation efforts.

Stefanie Linklater, Research Program Manager, Ottawa Hospital Research Institute
D’Arcy Duquette, Patient Advisor
Brian Johnston, Patient Advisor

Learning Objectives:

• Illustrate the role of patient collaboration in research and de-implementation efforts.
• Identify potential opportunities for integrating patients into research and quality improvement initiatives.
• Explore best practices and approaches for effective patient engagement.

UTI or Something Else? How to Improve Diagnostic Clarity Among Older Adults | Room 3

Urine dipsticks are no longer recommended for diagnosing urinary tract infections (UTIs) in older adults and have been de-adopted in most long-term care (LTC) homes across Canada. However, LTC residents still undergo testing when transferred to emergency departments, leading to higher rates of urine cultures and unnecessary antibiotic prescriptions. In this session, Dr. Jerome Leis will discuss challenges and successes in standardizing this practice across different health care sectors. Dr. Natalie Landry will share learnings and data from Manitoba on reducing unnecessary urine tests in emergency and urgent care by updating order sets since 2019.

Dr. Jerome Leis, Clinician Lead, Using Antibiotics Wisely, Choosing Wisely Canada
Dr. Natalie Landry, Clinical Biochemist, Diagnostic Services Laboratory Medicine, Shared Health

Learning Objectives:

• Describe the pitfalls in UTI diagnosis in older adults that lead to antibiotic overuse.
• Identify a standardized approach to diagnosing UTIs among residents of long-term care.
• Discuss challenges and successful examples of in promoting this approach beyond LTC.

Learn how to tackle overuse in your practice through workshop sessions and abstract presentations featuring innovative approaches from across the country. Participants can select one of the following sessions to attend.

QI’s Role in Environmentally Sustainable Health Care | Room 4 

Providers are becoming increasingly aware of the environmental impact of their practices, from waste generation to carbon emissions. Undertaking quality improvement initiatives can be effective in reducing low-value care while also tackling climate challenges. This session will share how quality improvement can drive and sustain environmentally conscious practices for more sustainable health care systems.

Dr. Brian Wong, Director, Centre for Quality Improvement and Patient Safety
Dr. Marko Balan, Internist
Dr. Nicole Simms, Executive Lead, Training and Education Lead, CASCADES

Learning Objectives:

• Describe the role of quality improvement in creating more sustainable health care systems.
• Identify examples of interventions to reduce low-value activities and their environmental impacts in health care.
• Develop strategies to build capacity for integrating climate and QI initiatives.

Abstracts on Reducing Unnecessary Lab Testing | Room 7/8

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature efforts to decrease unnecessary routine lab testing.

Long-Term Impact of Criteria-Based Serum 25-Hydroxyvitamin D Testing in Ontario
Dr. William Silverstein, General Internist, Sunnybrook Health Sciences Centre

Optimization of Emergency Department Laboratory Test Utilization by Patient Presentation
Dr. Natalie Landry, Clinical Biochemist, Diagnostic Services Laboratory Medicine, Shared Health

Defining Clinically Appropriate Criteria for Repetitive Laboratory Testing
Dr. Vanessa Arciero, Resident, University of Toronto

Eliminating Unnecessary RBC Folate Testing at Cambridge Memorial Hospital
Hayley Hamilton, Manager, Laboratory Medicine, Cambridge Memorial Hospital
Dr. Jacqueline Bourgeois, Chief of Laboratory/Pathology, Cambridge Memorial Hospital

Learning Objectives:

• Describe efforts to reduce low-value tests in hospital settings.
• Illustrate successful examples of implementation efforts in hospital settings.
• Identify tools and resources that can support clinicians in reducing unnecessary testing and treatments in hospitals.

Abstracts on Audit and Feedback and Appropriate Prescribing | Room 3

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will focus on audit and feedback strategies as an effective intervention to improve appropriate prescribing.

Decreasing Inappropriate Antibiotic Use in Primary Care Patients with Viral Respiratory Tract Infections
Dr. Alex Singer, Family Physician, Associate Professor, University of Manitoba

CANBuild-AMR: A National Collaborative Advancing Antibiotic Audit and Feedback for Primary Care
Dr. Kevin Schwartz, Antimicrobial Stewardship Physician, Public Health Ontario

Meta-Analysis of a Mailed Audit and Feedback Program in British Columbia
Dr. Colin Dormuth, Co-Director, Therapeutics Initiative, University of British Columbia

Academic Detailing in Saskatchewan: Supporting Improvements in Antibiotic Prescribing
Marlys Lebras, Information Support Pharmacist, RxFiles

Learning Objectives:

• Describe how audit and feedback can address inappropriate antibiotic prescribing.
• Illustrate successful examples of improvement efforts in antibiotic stewardship.
• Identify practical tools and resources to support clinicians and organizations in implementing audit and feedback strategies.

Deprescribing Competencies and How to Teach Them: An Interprofessional Workshop | Room 5 

Deprescribing, the process of reducing or stopping medications that are no longer necessary or that may be causing more harm, is essential in reducing low-value, potentially risky care. Yet, deprescribing is inconsistently integrated and taught in Canadian entry-to-practice health curricula such as medicine, pharmacy, or nursing. This workshop presents the essential competencies for deprescribing, and strategies to teach and assess these in educational contexts ranging from undergraduate courses to clinical practicums.

Dr. Emily McDonald, Associate Professor of Medicine, McGill University, and Director, Canadian Medication Appropriateness and Deprescribing Network
Dr. Barbara Farrell, Scientist, Bruyere Health Research Institute, Associate Professor, Department of Family Medicine, University of Ottawa

Learning Objectives:

• Describe deprescribing competencies and related knowledge and skill requirements.
• Identify gaps and opportunities to teach and assess deprescribing competencies.
• Apply tools and resources to develop a plan to integrate these competencies into teaching or precepting.

Will AI Help or Harm Overuse?

Artificial intelligence (AI) is quickly gaining traction in health care, offering the potential to streamline processes and improve efficiencies. But will AI help or harm efforts to reduce low-value tests and treatments? Dr. Amol Verma, Clinician-Scientist at Unity Health Toronto, will share the challenges and opportunities of integrating AI into health systems and discuss the critical role of providers in ensuring its appropriate use.

Dr. Amol Verma, Clinician-Scientist, Unity Health Toronto, Co-Lead, GEMINI

Learning Objectives:

• Describe the potential benefits and risks of AI for overuse in health care.
• Explore strategies for integrating AI responsibly into health systems to improve patient outcomes.
• Identify the role of providers in guiding AI implementation and minimizing unintended consequences.

Learn how to tackle overuse in your practice through workshop sessions and abstract presentations featuring innovative approaches from across the country. Participants can select one of the following sessions to attend.

Easing Workload Burden by Choosing Wisely | Room 4 

Primary care practices across the country face significant workload challenges. Reducing low-value tests and treatments—those that provide little or no benefit—is an opportunity to ease this burden while improving patient care. This session will offer practical guidance and effective strategies to streamline workflows and reduce unnecessary demands on providers.

Dr. Janet Reynolds, Primary Care Co-Lead, Choosing Wisely Canada
Dr. Guylène Thériault, Primary Care Co-Lead, Choosing Wisely Canada
Dr. René Wittmer, President, Choosing Wisely Quebec

Learning Objectives:

• Describe how reducing low-value care can alleviate unnecessary workload burden.
• Identify examples of low-value tests or treatments to eliminate or reduce in primary care practices.
• Practice effective strategies for discussing low-value tests and treatments with patients.

Setting a Target: Antipsychotic Use in Long-Term Care | Room 7/8

Recent data shows antipsychotics are often inappropriately prescribed to older adults in long-term care (LTC) who are not experiencing psychosis. This session will explore efforts to address this issue, including measuring inappropriate use, conducting a Delphi process, and creating outreach strategies to set a national target for the appropriate antipsychotic use in Canada.

Elizabeth Carson, Clinical Research Manager, Canada’s Drug Agency
Norma Hall, Program Consultant, Canadian Institute for Health Information
Tai Huynh, Campaign Director, Choosing Wisely Canada

Learning Objectives:

• Summarize current trends of inappropriate antipsychotic use in LTC.
• Explore strategies and methodologies for developing consensus on appropriate antipsychotic use.
• Discuss the development of a national target to promote appropriate antipsychotic use in Canada.

Abstracts on Tackling Lab Utilization in Canada | Room 5

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature efforts to tackle the challenges of lab utilization in Canada.

Barriers, Priorities, and Collaboration to Achieve Lab Wisely Goals
Dr. Amanda VanSpronsen, Associate Professor, University of Alberta

Re-Purposing the Ordering of Routine laboratory Tests (RePORT)
Dr. Anshula Ambasta. General Internal Physician, Assistant Professor, Department of Anesthesia, University of British Columbia

Leveraging a Regulatory College Partnership Program to Improve Laboratory Test Utilization
Dr. Hedieh Molla Ghanbari, Hospitalist and Clinician Educator, Sinai Health
Dr. Felix Leung, Clinical Biochemist, Sinai Health

Review of the 2024 Minimum Retesting Intervals for Lab Tests
Dr. Alex Singer, Family Physician, Associate Professor, University of Manitoba

Learning Objectives:

• Describe efforts to implement change in lab utilization.
• Illustrate successful examples of improvement efforts to tackle low-value labs at the individual and system levels.
• Identify tools and resources that can support clinicians and organizations in reducing low-value lab testing.

Abstracts on Choosing Wisely and Climate Action | Room 3 

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature initiatives tackling waste, harm, and our carbon footprint.

A Province-Wide Approach to Discontinue Desflurane Purchasing in NL
Dr. Krista Mahoney, Implementation Lead, Quality of Care NL

Putting Anesthetic Emissions of Desflurane Into Bed
Rizwan Ahmed, Director of Pharmacy, Southern Health-Santé Sud

Advocating for Sustainable Healthcare within Medical Organizations: Lessons from Rheumatology
Dr. Stephanie Tom, Division Head, Rheumatology, Trillium Health Partners

Building Climate Culture in the Healthcare System
Keith Parsons, Provincial Director, Planning and Policy, NL Health Services

Advancing Climate Action Through Standards and Accreditation
Dr. Myles Sergeant, Assistant Clinical Professor, Family Medicine, McMaster University
Dr. John McGraw, Executive Vice President, Health Standards Organization

Learning Objectives:

• Recognize the important role clinicians play in leading change in the climate crisis.
• Describe practical examples of environmentally sustainable initiatives to reduce overuse in practice.
• Discuss tools and resources to support clinicians in implementing environmentally sustainable practices.

Learn how to tackle overuse in your practice through workshop sessions and abstract presentations featuring innovative approaches from across the country. Participants can select one of the following sessions to attend.

Getting Back on Course: Advancing the Appropriate Use of Antipsychotic Medications in LTC | Room 7/8

Since the onset of the pandemic, potentially inappropriate antipsychotic use in long-term care (LTC) has been on the rise. What’s driving this trend, and how can it be reversed? This workshop offers a step-by-step approach to advancing the appropriate use of antipsychotics. Learn practical strategies and approaches from Healthcare Excellence Canada and the Institute for Safe Medication Practices Canada, who have supported staff in Canadian LTC settings to effectively address this issue. Hear from experts who have successfully implemented change and learn how to adapt their approaches to your own LTC home.

Neil Drimer, Director, Health Innovation Programs, Healthcare Excellence Canada
Cynthia Sinclair, Coach and Advisor, Healthcare Excellence Canada
Carolyn Hoffman, Chief Executive Officer, Institute for Safe Medication Practices Canada

Learning Objectives:

• Describe effective approaches in advancing the appropriate use of antipsychotics.
• Describe helpful strategies for implementing practice changes in LTC settings.
• Discuss resources to support and implement the appropriate use of antipsychotics in LTC settings.

Unlocking Nursing’s Full Potential: Embracing Best Practices of Quality Improvement for Nursing Education | Room 5

This bilingual guided session explores how nursing expertise can drive sustainable best practices, including implementation of Choosing Wisely recommendations. Through a critical examination of nursing education, participants will discuss innovations that engage nurses in continuous quality improvement.

Marie Chantal Leclerc, Professor, Department of Nursing, Université du Québec en Outaouais
Maryanne D’Arpino, Chief Nursing Executive, VP, Quality and Professional Practice, Spectrum Health Care
Julie Weir, Long-Term Care Clinician Co-Lead, Choosing Wisely Canada

Learning Objectives:

• Analyze barriers and enablers to nursing leadership in quality improvement initiatives.
• Identify key competencies, knowledge, and values needed to strengthen the nursing profession.
• Outline educational strategies to enhance leadership, mentorship, and professional empowerment.
• Develop approaches to ensure sustainability and transferability of nursing education into practice.

Abstracts on Resource Stewardship Perspectives | Room 4 

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature initiatives on understanding perspectives of resource stewardship in health care.

Choosing Wisely in Post-Pandemic Canada: Perspectives on Resource Stewardship
Div Patel, Medical Student, Northern Ontario School of Medicine University
Nathan Jeffery, Medical Student, Northern Ontario School of Medicine University

Patient-Centred Public Awareness: Choosing Wisely Together to Reduce Low-Value Care Through Conversation
Sarah Porter, Information Consultant, Island Health
Charuta Sahasrabudhe, Medical Student, University of British Columbia

Collaborating with Indigenous Peoples to Address Priorities for Medication Appropriateness
Amber Ruben, Pharmacist,  Misericordia Community Hospital
Jennie Herbin, Patient and Community Engagement, Canadian Medication Appropriateness & Deprescribing Network

Learning Objectives:

• Describe examples of strategies to understand perceptions of overuse and resource stewardship in practice.
• Recognize the important role of integrating diverse perspectives into quality and system improvement efforts.
• Discuss how broad engagement with patients, providers, and communities can inform the development of effective education tools.

Abstracts on Caring for Older Adults | Room 3

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature initiatives on appropriate prescribing and reducing overuse in the care of older adults.

Rate of Inappropriate Benzodiazepine and Sedative-Hypnotic Prescribing in Hospitalized Older Adults
Dr. Liv Cento, Internal Medicine Resident, University of Toronto

Assessing variation of Antipsychotic, Antidepressant, and Sedative Dispensations to Older Adults in Alberta Between 2021-2023
Sampson Law, Project Manager, Physician Learning Program

A Shift in Geriatric Care with Choose Wisely Canada’s Recommendations for Indwelling Urinary Catheters and Incontinent Products
Leslie Dryburgh, Clinical Nurse Specialist Geriatrics, Winnipeg Regional Health Authority

Learning Objectives:

• Outline effective approaches for reducing unnecessary testing and treatments in the care of older adults.
• Describe improvement examples to change existing prescribing or practice patterns.
• Discuss resources to support the appropriate care of older adults.

The Science of Doing Less: De-Implementation Research in Canada

In a health care system often driven by routines and habits, changing existing behaviours is a persistent challenge. In this session, Dr. Jeremy Grimshaw will share the progress of de-implementation research, offering strategies for change at both the individual and system levels.

Dr. Jeremy Grimshaw, Senior Scientist Emeritus, Methodological and Implementation Research, Ottawa Hospital Research Institute and Full Professor, Department of Medicine, University of Ottawa

Learning Objectives:

• Describe de-implementation research and its role in reducing low-value health care activities.
• Explore real-world examples of successful de-implementation research projects in Canada.
• Identify the key challenges and opportunities in advancing de-implementation science within health care systems.

Learn how to tackle overuse in your practice through workshop sessions and abstract presentations featuring innovative approaches from across the country. Participants can select one of the following sessions to attend.

Axe the Rx: Deprescribing Chronic Medications With PEER | Room 4

In this interactive, case-based session, presenters will explore practical strategies for deprescribing common chronic medications, including those that are less effective or no longer needed and reducing or simplifying challenging medications used for symptomatic conditions.

Dr. Jamie Falk, Clinical Pharmacy Specialist, and Assistant Professor, University of Manitoba
Dr. Allison Paige, Medical Lead, Kildonan Medical Centre, Seven Oaks General Hospital

Learning Objectives:

• Identify low-value medications for common chronic diseases.
• Develop an approach to deprescribing within practice.
• Apply patient-oriented approaches to deprescribing preventative and symptom-based medications.

Best Practices for Virtual QI Workshops that Effectively Engage Clinicians

This interactive workshop explores using virtual Audit and Feedback (AGF) for quality improvement in health care. Participants will experience a simulated AGF session, learn success factors for virtual delivery, and discuss best practices to adapt AGF for their own health systems

Dr. Douglas Woodhouse, Medical Director, Physician Learning Program

Learning Objectives:

• Identify key differences between in-person and virtual AGF methodologies.
• Explore success factors for effective virtual AGF sessions in health care.
• Describe strategies for planning and delivering virtual AGF in clinical settings.

Abstracts on Choosing Wisely in Long-Term Care | Room 5

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature efforts to decrease urine dipsticks and urinalysis.

The Culture of Requesting Cultures – UTI Testing and Treatment Analysis in Long-Term Care
Allison Bell, Long Term Care Pharmacy Manager, Winnipeg Regional Health Authority 

Elimination of Diagnostic Testing in Manitoba’s LTC Application Assessment Process
Joe Puchniak, Provincial Clinical Service Lead, Health System Integration and Quality, Shared Health
Mona Spencer, Clinical Consultant, Provincial Long-term Care and Community Care, Shared Health

Learning Objectives:

• Describe efforts to reduce unnecessary tests and treatments in long-term care.
• Illustrate successful examples of implementation efforts in long-term care settings.
• Identify tools and resources that can support clinicians in implementing change in long-term care.

Abstracts on Tackling Overuse in Hospitals | Room 7/8

Abstracts feature Choosing Wisely initiatives and innovative approaches from across the country. This session will feature projects on implementing Choosing Wisely improvement projects in hospitals.

Blood Conservation Quality Improvement Project in an Academic Multidisciplinary ICU
Dr. Christine D’Arsigny, Clinician-Scientist, Kingston Health Sciences Centre

Reducing Use of Intravenous Medications When Oral/Enteral Alternatives Are Safe and Effective
Loretta Lee, Drug Utilization Evaluation/Clinical Pharmacist, Scarborough Health Network
Swasti Bhajan, Director of Pharmacy, Scarborough Health Network

Dialyzing Wisely: Improving the Performance and Delivery of Acute Dialysis to Critically Ill Patients in Alberta
Kristin Robertson, Practice Lead, Alberta Health Services

Measurement & Evaluation of the New Transfusion Medicine Team on a Provincial Level
Andrea Nielsen, Nurse Coordinator, Blood Management, Shared Health
Brittani Rainkie, Nurse Coordinator, Blood Management, Shared Health

Learning Objectives:

• Describe efforts to reduce low-value tests in hospital settings.
• Illustrate successful examples of implementation efforts in hospital settings.
• Identify tools and resources that can support clinicians in reducing unnecessary testing and treatments in hospitals.

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada, and approved by the CPD Medicine Program, University of Manitoba for a maximum of 9.7 hours. Participants should only claim credit for the actual number of hours attended.

The University of Manitoba CPD Medicine Program is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME).

This activity has been certified by the College of Family Physicians of Canada for up to 9.5 Mainpro+® Certified Activity credits.