Everyone’s a winner if we test less: the CODA action plan
Oliver Walsh
A B * , Roger Harris C D , Oliver Flower C D , Matthew Anstey E F and Forbes McGain G H
A Intensive Care Unit, The Canberra Hospital, ACT, Australia.
B College of Health and Medicine, The Australian National University, Canberra, ACT, Australia.
C Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW, Australia.
D Faculty of Health and Medicine, Sydney University, NSW, Australia.
E Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
F School of Public Health, Curtin University, Perth, WA, Australia.
G Departments of Anaesthesia and Intensive Care, Western Health, Vic., Australia.
H Department of Critical Care, University of Melbourne, Vic., Australia.
Australian Health Review 46(4) 460-462 https://doi.org/10.1071/AH22145
Submitted: 9 June 2022 Accepted: 15 June 2022 Published: 1 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
In this era of ‘Choosing Wisely,’ we present a four-step action plan to reduce unnecessary pathology testing and the associated patient harm (blood loss through repeated phlebotomy), economic cost and environmental impact. The authors are experts from the CODA group; a medical education and health-promotion charity that aims to build on the Choosing Wisely initiative to provide meaningful and sustainable actions to reduce the carbon footprint of healthcare, globally. Pathology testing is expensive and carbon-intensive, with as many as half of all tests being not clinically indicated. Reducing unnecessary testing is the only effective way to decrease the carbon footprint and other associated costs, as opportunities to reuse and recycle pathology specimens are limited. The four key steps for action are (i) auditing local practice; (ii) defining unnecessary testing including developing a clinical guideline for rational ordering; (iii) educating stakeholders; and (iv) measuring the impact of the intervention through re-audit. This proven method is designed to be used in any healthcare setting around the world; having a small group of passionate ‘champions’ is thought to be as important as strong clinical governance and more important than access to sophisticated equipment. Electronic medical record systems and other technological solutions offer new ways to help establish a sustainability mindset and reduce unnecessary testing. The Codachange.org/coda-earth/ website provides a dynamic crowdsourcing platform through which we can collectively learn to meet the diverse needs of our international medical community. Self-reported outcomes are gamified through collaborative feedback, amplification via social media and the ability to earn rewards, be uploaded to the CODA website, or added to the template as a success story. By combining our existing local networks with the emerging international CODA community, we can initiate meaningful change now and enter the era of environmental stewardship.
Keywords: carbon cost, CODA, environment, environmental, greenhouse gas, over‐testing, pathology, sustainability, sustainable, test, testing, unnecessary.
References
[1] Choosing Wisely Australia. More is not always better when it comes to healthcare. 2022. Available at https://www.choosingwisely.org.au/[2] CODA. About CODA. 2022. Available at https://codachange.org/#about
[3] Australian Institute of Health and Welfare (AIHW). Health Expenditure Australia 2019-20. Canberra: AIHW; 2021.
[4] Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2 e27–35.
| The carbon footprint of Australian health care.Crossref | GoogleScholarGoogle Scholar | 29615206PubMed |
[5] Services Australia. Medicare Group Reports by MBS category processed from July 2018 to June 2019. 2022. Available at http://medicarestatistics.humanservices.gov.au/statistics/mbs_group.jsp
[6] National Coalition of Public Pathology. Encouraging Quality Pathology Ordering in Australia’s Public Hospitals. Canberra. 2012. Available at https://publicpathology.org.au/wp-content/uploads/2015/12/NCOPP-QUPP-Project-Final-Report.pdf
[7] Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis. PLoS ONE 2013; 8 e78962
| The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis.Crossref | GoogleScholarGoogle Scholar | 24260139PubMed |
[8] Hooper KP, Anstey MH, Litton E. Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis. Anaesth Intensive Care 2021; 49 23–34.
| Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 33554634PubMed |
[9] Wiser Healthcare. Wiser Carbon Neutral. 2022. Available at https://www.wiserhealthcare.org.au/wiser-carbon-neutral/
[10] Walsh OM, Davis K, Gatward J. Reducing inappropriate arterial blood gas testing in a level III intensive care unit: A before-and-after observational study. Crit Care Resusc 2020; 22 370–7.
| Reducing inappropriate arterial blood gas testing in a level III intensive care unit: A before-and-after observational study.Crossref | GoogleScholarGoogle Scholar |
[11] McAlister S, Barratt AL, Bell KJ, McGain F. The carbon footprint of pathology testing. Med J Aust 2020; 212 377–82.
| The carbon footprint of pathology testing.Crossref | GoogleScholarGoogle Scholar | 32304240PubMed |
[12] Theile H, Verstarkis L, Pietzsch A. Preoperative pathology ordering through the Pre-Anaesthetic Evaluation Unit. Featured stories, Choosing Wisely Australia. 2021. Available at https://www.choosingwisely.org.au/featured-stories/choosing-pre-operative-pathology-wisely
[13] Hiscock H, Neely RJ, Warren H, Soon J, Georgiou A. Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review. Pediatrics 2018; 141 e20172862
| Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review.Crossref | GoogleScholarGoogle Scholar | 29382686PubMed |
