Announcement: November 2015 Choosing Wisely Update

Announcement: November 2015 Choosing Wisely Update

Announcement: November 2015 Choosing Wisely Update

Team: ChoosingWiselyContent

Date: This is not a timed event.



More is not necessarily better when it comes to health care treatment. Unnecessary tests, treatments and procedures undermine our ability to provide care by potentially exposing patients to delays and even unintended harm; unnecessary testing takes away resources from our health care system that are required for new and improved diagnostics and treatments.. Here’s an update on key Choosing Wisely Manitoba projects addressing this important issue. 

Appropriate Vitamin D Deficiency Testing (25-OH)

Project goal

Reduce the number of unnecessary Vitamin D tests in Manitoba by 50%.


Vitamin D deficiency testing in Manitoba has increased exponentially over the last 8 years, from approximately 5,000 in 2006 to a forecasted 50,000 completed tests in 2015/16. Evidence based guidelines advise against routine testing. However, it is estimated that approximately 90% of current vitamin D tests are completed on patients without medical indication.

Next steps

Watch for new guidelines for Vitamin D testing criteria and a Vitamin D specific ordering requisition to be distributed in the next few months. Our main focus is to support physicians in ‘choosing wisely’ with their patients, ensuring that Vitamin D tests ordered are medically indicated. A physician/patient toolkit will include awareness and education materials, including additional support for physicians who may not realize that they are ordering a disproportionately high number of Vitamin D tests. 

Improving Preoperative Diagnostic Testing

Project goal

Ensure all Manitobans receive the necessary and appropriate preoperative diagnostic testing for elective surgeries.


We are developing strategies to ensure the sustainable implementation of standardized, evidence-informed clinical practice guidelines that will reduce unnecessary surgery delays (due to awaiting tests results), reduce patient inconvenience and discomfort (travel and time; needle pokes) and avoid stressful ‘false positive’ results that could potentially result in further unnecessary investigation. We are targeting the highest volume surgical specialties (Ophthalmology, Orthopaedic, and General Surgery) to maximize potential impact.

Completed to date

• Revised Cataract H&P form to remove cues that prompt unnecessary tests

• Extensive stakeholder engagement

Next steps

• User evaluation of cataract history and physical form (more information to come in December)

• Standardization of Orthopedic surgeon preoperative package

• Revision of preoperative diagnostic testing guidelines 

*** As a point of contact for patients, physicians like you are key to realizing these goals and to improving appropriate diagnostic testing and treatment. ***

About Choosing Wisely Manitoba

Following the principles and goals of Choosing Wisely Canada, The Centre for Healthcare Innovation (CHI) is partnering with Diagnostic Services Manitoba (DSM) on a number of Choosing Wisely projects where there is an opportunity, specific to Manitoba, to improve the appropriate use of diagnostic testing in our province. Choosing Wisely Manitoba
is supported by the Manitoba College of Family Physicians. Future planned projects include: D-Dimer/Imaging for DVT and PE, imaging for lower back pain, imaging for headache and head pain, and fecal occult blood tests (FOBT). 

Please visit and to learn more. 

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