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Learning to echo wisely: WIHV explores new ways to reduce unnecessary heart tests

September 11, 2017

By Ian McMillan

Dr. Sacha Bhatia
Dr. Sacha Bhatia

Researchers at the WCH Institute for Health System Solutions and Virtual Care (WIHV) have done it again, this time by looking at how providing feedback to physicians could reduce strain on our healthcare system and, ultimately, protect patients. Dr. Sacha Bhatia, WIHV director and staff cardiologist at WCH and UHN, and his team recently published their findings in the Journal of The American College of Cardiology, where they concluded that novel educational tools and feedback may improve the use of imaging - and reduce unnecessary and potentially harmful testing.

In what they are calling Echo WISELY (standing for “Will Inappropriate Scenarios for Echocardiography Lessen Significantly”), Dr. Bhatia and his team recruited 179 physicians in Canada and the United States, a portion of whom would receive email-based educational sessions and a brief video about the appropriate use of echocardiography. Monthly audits followed, showing physicians how appropriate their imaging tests were, based on appropriate use criteria. Results showed that physicians who received the feedback ordered significantly fewer “rarely appropriate” echocardiograms (8.8 per cent) versus those in the control group (10.1 per cent).

The implication here is that providing physicians with feedback on their use of testing, and allowing them to see how they compare to their peers, provides them with pause to consider whether their actions were appropriate, and whether the tests they ordered actually benefitted patients.

In Canada, up to 30 per cent of medical tests are unnecessary; and, according to Dr. Bhatia, unnecessary echocardiograms could account for over $190 million in annual spending alone. Speaking with Roundhouse Radio’s Kirk LaPointe, he explained how some of these issues affect the healthcare system more broadly. Further to this, this kind of testing has the potential to put patients at risk, creating both practical and financial incentives to actively reduce over testing.

The results of this study certainly bring up more questions - about creating long-term behavior change for physicians, widespread adoption of this method of feedback, and what other forms of feedback may be effective. But these are precisely the types of questions that WIHV and WCH enjoy asking - for our healthcare system and for the patients we serve.

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