Allégeons la charge de travail

En faire moins, c’est plus de temps pour ce qui compte.

Ce ne sont pas tous les tests ou traitements qui mènent à de meilleurs soins. Ceux de faible valeur, qui n’offrent que peu ou pas de bienfaits, peuvent prendre du temps au détriment des soins appropriés, augmenter la charge de travail des professionnelles et professionnels de la santé et exercer une pression supplémentaire sur les systèmes de santé et l’environnement.

Alors que les prestataires de soins de santé à travers le pays sont confrontés à une charge de travail croissante, la réduction des soins de faible valeur est un moyen concret d’alléger le fardeau et de se concentrer sur les besoins prioritaires de la patientèle.

Alléger la charge de travail est un des avantages connexes de l’intégration des recommandations de Choisir avec soin.

Le temps des professionnels et professionnelles de la santé est une ressource limitée. Le concept du temps nécessaire pour traiter (TNT) (article en anglais) encourage les professionnelles et professionnels de la santé à prioriser avec attention le temps autant que tout autre aspect des soins. La calculatrice de TNT a été développée pour aider à estimer le temps consacré à des soins de faible valeur. Consultez la section ci-dessous pour essayer la calculatrice de TNT par vous-même!

Les exemples suivants se servent des estimations de TNT pour illustrer comment l’intégration des recommandations de Choisir avec soin Canada peut réduire la charge de travail des professionnelles et professionnels de la santé.

Analyse sanguine courante

Étude de cas : comment le fait d’éviter les analyses sanguines inutiles permet de gagner jusqu’à 20 jours de travail par année.

Ostéodensitométries DEXA

Étude de cas : comment le fait d’éviter les densitométries osseuses inutiles permet de gagner jusqu’à 7 jours de travail par année.

Imagerie pour douleurs lombaires

Étude de cas : comment le fait d’éviter les imageries pour des douleurs lombaires inutiles permet de gagner jusqu’à 10 jours de travail par année.

Calculatrice de temps nécessaire pour traiter

La calculatrice de temps nécessaire pour traiter (TNT) estime le temps passé sur les soins de faible valeur selon votre pratique et vos habitudes. Elle peut encourager la réflexion sur vos décisions quotidiennes et favoriser la prestation de soins plus efficaces basés sur des données probantes.

Essayer la calculatrice
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How to use the calculator ?

When the calculator asks for a number, assume the time is in minutes, and do not provide units or decimals or percentage symbols.

What are you trying to calculate the ''time needed to treat'' for ?

There are three ways TNT can be calculated

By using the percentage of your patients who have a specific condition or who would be eligible to an intervention for which you want to calculate the TNT (this is ideal to estimate time needed to treat associated with screening)

By specifying how often you encounter a situation or perform an action on a monthly basis

By using using population-based parameters (this is ideal when planning a public health or large-scale intervention)

How would you like to estimate how many patients this would apply to in your practice ?

How many patients do you have in your roster ?

To what percentage of your patients does the recommendation apply ? (%)

How long does discussing / prescribing or doing the intervention take you with each patient, on average (minutes) ?

What is the percentage of test results that come back abnormal (%) ?

Estimates for common tests

How much time does discussing and planning follow-up for normal results take you on average (minutes) ?

How much time does discussing and planning follow-up for abnormal results take you on average (minutes) ?

Every how many years should the intervention be performed ?
For example, if the intervention is screening and should be done every year, put ''1'' ; if the intervention should be performed more than once a year, provide a decimal (e.g. 0,5 for screening every 6 months)

We estimate it would take you the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all your eligible patients, on a monthly basis :

We estimate it would take you the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all your eligible patients, on a yearly basis :

We estimate it would take you the following time (provided in hours) to perform this intervention over a 25 year period of time with the specified interval, including time to manage normal and abnormal results for all your eligible patients :

How many time do you perform or recommend this intervention per month, on average ?

How much time does the intervention take (prescribing the test or treatment, including discussing it and or performing it, if applicable) ?

If this is a test or a physical exam, on what percentage of occasions does it reveal something abnormal (%) ?
Leave this field empty if this does not apply / the intervention is not related to testing

Estimates for common tests

How long does managing normal results take you on average (minutes) ?
Leave this field empty if this does not apply / the intervention is not related to testing

How long does managing abnormal results take you on average (minutes) ?
Leave this field empty if this does not apply / the intervention is not related to testing

We estimate it would take you the following time (provided in hours) to perform this intervention every month, including time to manage normal and abnormal results :

We estimate it would take you the following time (provided in hours) to perform this intervention every year, including time to manage normal and abnormal results :

We estimate it would take you the following time (provided in hours) to perform this intervention over a 25 year period, including time to manage normal and abnormal results :

What is the population size ?

To what percentage of of the population does the recommendation apply ? (%)
If you have a direct number you would like to input, you can simply specify it in the ''Population size'' box, and write 100 % in the percentage of the population the recommendation applies to.

How long does discussing / prescribing or doing the intervention take with each patient, on average (minutes) ?

What is the percentage of test results that come back abnormal or call-back rate (%) ?

Estimates for common tests

How much time does discussing and planning follow-up for normal results take on average (minutes) ?

How much time does discussing and planning follow-up for abnormal results take on average (minutes) ?

Every how many years should screening be performed ?
If screening should be performed more than once a year, provide a decimal (e.g. 0,5 for screening every 6 months)

We estimate it would take the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all eligible patients :

We estimate it would take the following time (provided in hours) to perform this intervention over a 25 year period of time with the specified screening interval, including time to manage normal and abnormal results for all eligible patients :

We estimate implementing the measure, including time to manage normal and abnormal results for all eligible patients, requires this number of full-time clinicians every year, assuming a person works 40 hours per week, 48 weeks per year :

Reflecting on your "time needed to treat" (TNT) calculations can be a pivotal moment in your clinical practice. This exercise goes beyond numbers—it challenges us to think critically about the value and timing of the tests and treatments we recommend. How did your results compare to your expectations? Were there instances where you reconsidered the benefit of a specific intervention in relation to the time investment? Is there solid evidence to support the intervention? Reflecting on these questions, and considering potential harms, helps us align our clinical decisions with evidence-based practices, ultimately improving patient outcomes.

As you process this, consider the principles of the Choosing Wisely campaign, which advocates for reducing unnecessary interventions and focusing on what truly benefits patients. Are there areas of your practice where you might streamline treatment or reconsider the timing of interventions? Access resources on Choosing Wisely Canada's website to guide your reflection.

Lastly, reflection is not just an intellectual exercise; it's an opportunity for professional growth. If you're a family physician, consider utilizing tools like the CFPC's Mainpro Linking Learning Exercises, where reflective practice can be tied to continuing professional development (CPD) credits. If you're a Quebec physician, this can be used to claim category ''B'' credits.

If you're a specialist, explore the Royal College for similar reflective learning tools to support your ongoing education.

This process can facilitate real change, helping you break down barriers to implementing insights gained from exercises like TNT. By downloading a PDF summary of your TNT calculations, you can use this as a concrete reference in future reflective exercises, ensuring that the insights gained today are put into practice in your future clinical decision-making.

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About Choosing Wisely Canada

Choosing Wisely Canada 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.

Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada

Allégez votre charge de travail grâce à Choisir avec soin

Un webinaire qui démontre comment l’intégration des recommandations de Choisir avec soin peut aider à réduire la charge de travail. (vidéo en anglais)

(Diminuer la surutilisation grâce aux recommandations misant sur le concept du temps nécessaire pour traiter) (article en anglais)

Un article évaluant le temps nécessaire pour accomplir des tâches cliniques courantes de faible valeur et présentant des outils pour favoriser la pratique axée sur la réflexion.

Allégeons la charge de travail

Aperçu

Exemples pratiques