Using Labs Wisely: A collaboration between Choosing Wisely Canada and over 150 Canadian hospitals

BACKGROUND: Many in-hospital laboratory tests are unnecessary. Unnecessary testing is associated with patient harm, fiscal inefficiency, and environmental waste. OBJECTIVES: In 2021, Choosing Wisely Canada launched the Using Labs Wisely (ULW) hospital collaborative to (1) build national expertise on reducing unnecessary testing, (2) share testing data, and (3) spread quality improvement (QI) initiatives. This process evaluation describes the development, implementation, and program engagement. METHODS: ULW hospitals participate in web-based education/networking, national benchmarking via comparative reports, and QI initiatives. Hospital engagement was measured by enrollment, data submission, and presentations of QI progress. Comparative reports include inpatient testing volumes normalized to bed-days between hospitals (peer) and within hospitals (self) over time. Overall engagement and interventions used in QI programs are summarized. RESULTS: From January 2021 to February 2026, 157 hospitals from 6 provinces joined ULW, including 91 (58%) academic, 64 (41%) community, and 2 (1%) pediatric. 91 (58%) submitted testing data. Eight low-value test indicators include: coagulation profiles, aspartate aminotransferase (AST), urea, creatinine-kinase MB isoenzyme, serum or red blood cell folate, vitamin B12, erythrocyte sedimentation rate, and urine cultures. 67 (43%) hospitals presented during 39 collaborative project status updates. Urea, AST, and coagulation testing were the most intervened on. Most interventions (57/73, 78%) use multimodal strategies including education, audit and feedback, order set modification, and test ordering rules. CONCLUSIONS: ULW is a national QI collaborative to reduce low-value hospital laboratory testing. Keys to engagement include robust national representation, leveraging data, and facilitating spread of successful QI initiatives.