Using resources wisely in the COVID-19 pandemic: an international list of Choosing Wisely recommendations

Abstract

BACKGROUND: The novel coronavirus (COVID-19) pandemic has brought forth issues of health system resource limitations into urgent matters of public importance. Our objective was to rapidly develop an international Choosing Wisely list of recommendations for clinicians and the public about using resources wisely in the COVID-19 pandemic. METHODS: Choosing Wisely Canada convened a rapid Delphi process to develop an international Choosing Wisely list for COVID-19. Informed by a rapid review of emerging literature, this process engaged a small group of clinicians and public advisors in Canada (n=10) and internationally (n=8) to develop a candidate list of recommendations. A survey with candidate recommendations was sent to Choosing Wisely clinician leaders in Canada and around the world. Based on survey results and input, list recommendations were modified. RESULTS: The survey was sent to 293 potential respondents and received a 56% response rate in 72 hours (n=163). Respondents were asked to score each of the 9 recommendations on a 5-point Likert scale ranging from 1 strongly disagree to 5 strongly agree followed by free text comment. There were 271 total comments across 9 recommendations. Overall, all 9 recommendations had high levels of agreement with 83%-96% of respondents ranking them as strongly agree or agree. INTERPRETATION: This list of recommendations provides evidence-based statements about using resources wisely in the COVID-19 pandemic. The list reflects international consensus on evidence-based recommendations for both clinicians and the public which were achieved through a rapid consensus building process. TRIAL REGISTRATION: n/a