New Recommendations for Choosing Wisely Canada for Medical Laboratory Professionals: Spotlight on Wise Transfusion Practices

Amanda VanSpronsen, MLT, PhD
Associate Professor, University of Alberta

Choosing Wisely Canada (CWC) aims to reduce unnecessary medical tests, procedures, and treatments. They support the development and publication of practice recommendations from numerous medical societies. In 2020, the Canadian Society for Medical Laboratory Science (CSMLS) submitted its first set of seven recommendations for CWC. As part of CWC requirements, these recommendations are focused within the scope of practice of medical laboratory professionals (MLPs), primarily Medical Laboratory Technologists and Assistants. In 2024, CWC accepted another seven recommendations from the CSMLS, bringing the total to fourteen. All recommendations published with CWC start with the word “Don’t…” but they are not hard and fast rules. They serve as cues meant to prompt reflection and support conversations about change or concerns in the workplace.

The first set of recommendations was quite general and applicable across multiple areas of practice. For example, recommendation #2 is “Don’t proceed with testing or reporting when sample quality or identification is suspect.”  The new set of recommendations introduces more discipline-specific items and highlights the collaborative role MLPs play in reducing unnecessary tests and procedures. Readers may be particularly interested in recommendation #11:  “Don’t process transfusion orders that do not adhere to best practices without discussing with the ordering clinician.” As all MLPs know, blood products need careful stewardship due to their finite nature and potential to cause patient harm. Many jurisdictions have enacted restrictive, evidence-based transfusion guidelines, but inappropriate orders still occur.

For instance, two studies of several Canadian hospitals showed that almost 19% of red blood cell transfusion orders [1] and just over 41% of adult platelet transfusion orders [2] were inappropriate. In both studies, researchers concluded that MLT involvement in reviewing orders added value. All stakeholders are accountable for ensuring guidelines are followed. As testing-process experts, MLPs can play a key role in screening transfusion orders and liaising with laboratory physicians, other MLPs, and ordering clinicians to make sure the test order is appropriate. With this new CWC recommendation, MLPs have even more backing when advocating for practices and programs that decrease inappropriate transfusions.

All of the CWC recommendations for Medical Laboratory Science, along with justification and supporting evidence, can be found on the Choosing Wisely Canada [3] and Lab Wisely (CSMLS) [4] websites.  Understanding and applying these recommendations will help MLPs ensure responsible use of medical resources in the quest to provide the highest quality care.

References:

1. Kron AT, Collins A, Cserti-Gazdewich C, Pendergrast J, Webert K, Lieberman L, et al. A prospective multi-faceted interventional study of blood bank technologist screening of red blood cell transfusion orders: The START study. Transfusion. 2021 Feb;61(2):410-422. doi: 10.1111/trf.16243.

2. Hill-Strathy M, Pinkerton PH, Thompson TA, Wendt A, Collins A, Cohen R, et al. Evaluating the appropriateness of platelet transfusions compared with evidence-based platelet guidelines: An audit of platelet transfusions at 57 hospitals. Transfusion. 2021 Jan;61(1):57-71. doi: 10.1111/trf.16134.

3. Choosing Wisely Canada. Medical Laboratory Science. Fourteen tests and treatments to question. [Internet]. Available from: https://choosingwiselycanada.org/recommendation/medical-laboratory-science/

4. Canadian Society for Medical Laboratory Science.  Lab Wisely. Recommendations Made by You. [Internet]. Available from: https://labwisely.ca/medical-laboratory-profession-cwc-recommendations/

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