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Quality Improvement

Choosing Wisely in Hospitals

Ontario’s provincial priority for Choosing Wisely Canada in the hospital sector focuses on reducing preoperative testing in non-cardiac situations and optimizing blood transfusions. These recommendations have broad applicability across Ontario’s hospitals and can significantly impact patient outcomes.


Pre-operative testing

Conducting baseline laboratory investigations before low-risk non-cardiac surgery adds little value to pre-operative care. A focused clinical history and physical examination may reliably identify relevant abnormalities sought by routine laboratory testing before low-risk non-cardiac surgery. In addition, evidence suggests abnormal results in this setting only rarely influence care and do not improve clinical outcomes.

Electrocardiograms or ECGs performed before elective, non-cardiac, surgeries are frequently abnormal, especially when testing older patients and do little to improve risk prediction. Serious cardiac events like heart attack are rare following low-risk surgeries and there is little clinicians can do to lower this risk further. A preoperative ECG will not improve outcomes, but may lead to more unnecessary testing or treatment. ECGs used to identify the cause of symptoms (such as palpitations, chest pain, dyspnea, etc.) remain useful diagnostic tools regardless of whether the patient is having surgery.

Hospital sector pre-operative testing recommendations:

  • Avoid routine preoperative laboratory testing for low risk surgeries without a clinical indication
  • Don’t perform stress cardiac imagining or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery


Resources to help choose pre-operative testing wisely:


Transfusion medicine

The Canadian Society for Transfusion Medicine compiled a list of recommendations to maximize the safe and appropriate management of blood and related products, and to deliver the best possible evidence-based care to patients. Evidence supports a restrictive red blood cell transfusion approach to reduce unnecessary transfusions and risks associated with transfusion. The benefits of appropriate red blood cell transfusions for the health system include managing adverse events and reduced costs for collecting, processing and testing red blood cell units.

Hospital sector transfusion medicine recommendation:

  • Don’t transfuse blood if other non-transfusion therapies or observation would be just as effective

Resources to help choose transfusion medicine procedures wisely:


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If you have a question about Choosing Wisely Canada or want to learn more about how to get involved, please email us at


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