Toolkits from Choosing Wisely Canada

At the Choosing Wisely national meeting March 30th, Choosing Wisely Canada (CWC) announced a new direction.

In lieu of the 10 million challenge, they are instead putting significant effort into empowering CWC enthusiasts by way of facilitating "DIY Toolkits."

These tool-kits are PDF documents, starting with a catchy title and cover art (provided by CWC), and filled with user-generated content, meant to enable you to apply some of the Choosing Wisely recommendations to your institution or practice. So far, the topics include reducing unnecessary indwelling (Foley) catheter use, proton-pump inhibitor prescriptions, 2nd units of red blood cell transfusions, pre-operative investigation, and sedative/hypnotic use in the elderly.

Click on the image below to check out the first 5 or go to the page to learn how to submit your own:


Transfusion Medicine for Physicians

Did you know that there is an online, CME-Accredited course regarding the use of blood products?

In the area of transfusions, Less is often more!

Emergency and Family physicians, hospitalists, internists, residents and surgeons could all benefit from learning the when, why, and hows of transfusion.


See the PDF Flyer or go to the website to learn more and register!


Overall Learning Objectives:
After participation in this course, the learner will:

1. Appropriately interpret clinical signs and symptoms of reduced oxygen carrying capacity and utilize hemoglobin concentration to determine need for RBC transfusion.
2. Be confident their RBC transfusion ordering practice is up to date and reflects current literature.
3. Apply the appropriate elements of informed consent for transfusion.
4. Appreciate the indirect relationship of common coagulation tests to bleeding risk and the role of frozen plasma transfusion.
5. Recognize and respond appropriately to adverse transfusion events or reactions.
6. Know where to seek further advice on transfusion management.



Shrinking demand for blood products behind closure of blood donor clinics

Too much blood.

Remembering last year's crisis  – a severe shortage of blood products in Canada – it was surprising to read that Canadian Blood Services will be shutting down four permanent and 16 mobile clinics.

I am a blood donor.* It is with delight that I learn we have too much blood.

Experts cite five main reasons for this surplus:

  1. Minimally-invasive/robotic surgery reduces the amount of blood needed for each patient
  2. Doctors are transfusing when patients have symptoms, not for an arbitrary hemoglobin number (thanks to recommendations that have been made more popular thanks to initiatives like Choosing Wisely, eg item 5 on this list)
  3. Pre-surgery management can help increase patient's blood counts
  4. Better drugs during surgery prevent blood loss
  5. Blood supply is better managed by sharing blood products through hospital networks

It would be interesting to know which of these is has been the most effective at reducing the amount of blood required, but it sounds like most of these are in the best interests of patients and it results in a savings of $2.9 Million annually. However it happened, this is a big win for Canadians.


Well, I have donated blood, but every time I travel overseas (often to areas where malaria is present) it seems to prohibit me from donating for a year, and then I got my weird medical condition, so it has been about 3 years since I last donated.