Sustainable Healthcare Case Study: Reducing Low-Value Tests in the Barwon Health Emergency Department
Tuesday 06 May 2025
Barwon Health services a population of 350,000 in and around Geelong, Victoria, extending to 500,000 for some tertiary services offered across the wider Barwon South West region. The catchment also has around seven million visitors each year that impact on service demand.
Barwon Health has reduced selected low value tests in the Emergency Department (ED) in Geelong, Australia by between 40% and 50% per year, saving time, money and reducing CO2 emissions.
The problem:
Choosing Wisely Australia is an initiative of NPS MedicineWise aimed at reducing unnecessary, low-value and sometimes harmful care in Australia. According to Choosing Wisely, 25%–75% of tests in Australian primary care are not supported by evidence or expert opinion, and many common tests are used inappropriately. Furthermore, it is estimated that between 15% and 20% of total health care expenditure across all OECD nations is wasted (OECD, 2017). Apart from the financial costs to the health service, consequences to the patient of unnecessary or harmful testing and interventions can include pain, injury, anxiety, additional medical costs, travel costs and lost wages.
Goals:
- Financial sustainability - We live within our means, and we grow our capacity.
- Environmental sustainability - We aim to achieve net zero emissions by 2045 to reduce the impact of climate change on the health of our community.
- We always aim to improve the value of our services.
- We apply evidence to improve care.
- Right care, right time, right place, right way.
The process:
A multi-disciplinary group of Barwon Health emergency department staff has initiated a “No Unhelpful Tests” (NUT) committee to help reduce the expanding number of low-value tests being ordered in the emergency department.
- Initial guidelines: In October 2023, the NUT team rolled out their first project, targeting the use of the most labour- intensive, frequent and expensive tests. This included rapid COVID-19 ‘Qiagen’ PCR, venous blood gases (VBGs) and coagulation tests. Clear test indication guidelines were established, drawing from local data as well as international evidence.
- Behavioral drivers: The team canvassed emergency staff to identify the behavioural drivers that were leading to overuse of specific tests. In one instance it was found to be effective to move the VBG test kits to a single centralised storeroom, instead of being dispersed in trolleys around the department.
- Education: An educational program was implemented, which included displaying posters throughout the emergency department, developing specialised request forms and relocating tests to optimise their appropriate use.
The outcome:
The project has yielded early success. Qiagen ordering has decreased by 41%, VBG ordering by 53% and Coagulation tests by 48%, saving an estimated $885,000 per year in pathology costs and 726 hours per year of staff time with no adverse effects identified.
- Environmental: Total reduction in emissions was estimated to be 906 kg CO2-e per year.
- Financial: Annual savings from the reduced number of tests were estimated to be around $885,000, based on a comparison of test numbers in April 2023 to April 2024. In addition, staff time for testing was reduced by around 726 hours per year, or around 91 eight-hour shifts. Assuming an average hourly rate of $50 this added a further $36,000 to the annual financial savings.
- Patient care: No adverse events were identified.
Next steps:
The NUT committee will next focus its work on unhelpful troponin ordering, ECGs, Chest Xrays, delirium screens, and various CT modalities in collaboration with medical, surgical and cardiology inpatient teams.
