Choosing Wisely Canada's transfusion recommendations find a new outlet via BloodTechNet

Choosing Wisely Canada transfusion recommendations brought to "life" in video form by Dr. Clinton Campbell and his creative team

Since 2011, many excellent educational resources have come to life through Canadian Blood Services' BloodTechNet program. Resources like the videos below: 

Find all of the videos here on Canadian Blood Services' Professional Education website.

In this Q&A, Dr. Clinton Campbell explains how the funding his team received through the BloodTechNet program brought the Choosing Wisely Canada recommendations to life in video form. 

Who are you and what do you do?

My name is Dr. Clinton Campbell, I am a hematopathologist based in Halifax, Nova Scotia. The specialty of hematopathology in Canada involves all aspects of laboratory hematology, including the practice of transfusion medicine. I am currently the assistant medical director of the Halifax blood transfusion service. This role encompasses all aspects of transfusion medicine such as reviewing antibody serology to ensure the best transfusion for patients to inventory management and laboratory quality, as well as professional education.

The underlying tenant of our blood transfusion service is to work toward the safest, most responsible and best transfusion practice possible. Like any medical procedure, test or intervention, transfusion of a human blood product involves a careful balance of both risks and benefits posed to patients.

As physicians, we strive to ensure the risks outweigh the benefits, but as in any field there is always room for improvement. In this context, if there is one single question that I would say underlies the practice of transfusion medicine, which is “how can we mitigate risk and maximize benefit when we transfuse human blood products?” Answering and addressing this critically important question is essential in achieving the goal of best transfusion practice. 

What is Choosing Wisely Canada?

Choosing Wisely Canada (CWC) is an initiative designed to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to support physician efforts to help patients make smart choices to ensure safe, high-quality medical care.

There are currently more than 40 medical specialties involved with CWC. Each of these specialties was asked to create a list of “five things physicians and patients should question”, in regard to test ordering, medical procedures or interventions within the specialty. These lists are based on scientific evidence of potential inappropriate use or harm to patients, and each statement begins with the word “don’t” or “avoid”.

CWC lists are not meant to discourage physicians from ordering tests or procedures, but simply to open discussion and provide room for a second thought, allowing for the most well-informed, scientific and safe approach to test and procedure ordering.

Why is Choosing Wisely Canada relevant to transfusion medicine?

In my opinion, CWC has special relevance to transfusion medicine for a few reasons: 

1. The administration of a human blood product is always associated with a range of potentially serious adverse events;
2. Blood products are a scarce resource that are extremely dependent on a stable donor pool; and
3. Transfusion of human blood products is one of the most common procedures performed in hospitalized patients.

To address these issues, the Canadian Society for Transfusion Medicine (CSTM) developed a list of “ten things physicians and patients should avoid” in respect to transfusion medicine. One of the concerns regarding the efficacy of the CWC campaign in all disciplines is whether simply publishing lists is effective in changing physician practice.

Several studies suggest there is still significant work to be done toward effective dissemination, and while publishing lists is useful toward opening discussion, true practice change requires more widespread exposure to these recommendations. This recognized need for improvement provided a starting point for our partnership with CSTM, CWC and Canadian Blood Services to produce these videos.

How did you decide what resources and channels would best serve your goals?

As a starting point, we asked how we might develop a more effective, memorable and lasting dissemination strategy with high accessibility and exposure for the CWC transfusion recommendations. If you are at all like me (and have a short attention span), you would probably prefer to watch an educational video versus reading a guideline. And to be honest, this can be a more enjoyable, entertaining and resonant delivery method.

Video-sharing platforms like YouTube have been shown to have several advantages over publication in some types of physician education, and in addition to providing wide and highly accessible dissemination, it allows for the collection of audience data metrics. This in turns allows for an optimized and informed dissemination strategy.

So, our starting question was “can we develop a series of short, informative and entertaining animated videos for accessible and effective dissemination of CWC guidelines in transfusion medicine?” The immediate answer was yes, but, we needed an amazing team with the right skillset as well as funding to support the effort.

How did you use the BloodTechNet award to develop these resources?

The mandate of Canadian Blood Services’  BloodTechNet award fit perfectly with our goals, and this award provided the key funding needed to get the project off the ground. We were fortunate enough to partner with the outstanding and talented Faculty of Digital Animation as the Nova Scotia Community College (NSCC), which provided the creative and technical expertise to turn our vision into a reality.        

What was your experience in developing these resources?

The experience of actually making the videos was a challenging, fascinating and highly rewarding process for everyone involved, I think. Our goal was to make a series of five, high-quality, digitally animated videos, each showcasing one of the “top-ten” CWC transfusion medicine guidelines.

The videos would be posted on YouTube for both accessible dissemination and collection of data metrics. Our guiding criteria for making the videos from the start were that they needed to be short (less than two mins); highly focused and informative; of professional quality; and perhaps most importantly, we wanted them to be enjoyable and entertaining for maximum impact and memorability.

The transfusion guidelines selected for the videos were based on both the importance on the CWC list (those considered of highest importance are listed at the top) as well as on personal experience in clinical practice. Medical expertise was provided by myself, as well as colleagues from across Canada.

Who was on your team?

Our creative team consisted of four digital animation students at NSCC, a supervising faculty member, a professional sound editor and voice actor.

At the start of the project, in May of 2017, Canadian Blood Services kindly provided the creative team with a tour of the production facilities in Dartmouth, Nova Scotia, for a “hands-on” appreciation of blood product manufacturing and transfusion in Canada.

We then started our creative approach, relying on digital collaborative tools such as Google Hangouts and Slack to facilitate the process. We actually only met face-to-face once; all other meetings were virtual. Meetings were usually held on a weekly or bi-weekly basis.

How did you get started?

We started by making rough storyboard sketches of ideas based on scripts that I had written covering the five CWC transfusion medicine guidelines.

One of the biggest challenges at the start was how to convey a great deal of complex medical expertise into a simple, yet accurate graphical form rendered by our creative team of non-medical experts. We quickly adapted to this challenge, and through iteration after iteration, we saw our objectives materialize. I think our creative team had become transfusion medicine experts themselves by the time the videos were completed!

We completed production of the first video from start to finish, which allowed us to work out the creative process and produce the graphics or “assets” needed to produce the remaining four. Once these were in place, the process was much more efficient. All of the videos were designed around a common graphical motif, but each was created by an individual animator within our team. So each video has its own individual character within a common theme.

How long did it take?

The time from actual storyboarding of the ideas to final drafts was approximately six months, including both professional voice narration and sound editing. It was extremely rewarding to see the project move from a basic idea to a finished product that exceeded all of our initial expectations.

Who will use the videos, and how will they be viewed and disseminated?

These are intended for professional education, and we hope they will be used by colleagues, residents, medical students and other allied health professionals to help foster best transfusion practice. To date, they have been posted on the CSTM and Canadian Blood Services websites, as well as the Canadian Blood Services and Choosing Wisely Canada YouTube channels.

We have had a highly encouraging number of views in a short time, suggesting dissemination has been quite effective so far. For example, colleagues in Toronto have been highly supportive by integrating our videos into their transfusion education curriculum and circulating via Twitter.

Data metrics will be examined after six months to have some objective measure of the efficacy of dissemination. Later, we hope to produce videos for the additional five CWC transfusion guidelines, if we can find sufficient funding.

Fun fact: The animators and myself have discussed the idea of forming  a small startup company to facilitate additional similar projects, as we have had a great deal of enthusiasm and interest for a number of projects involving both professional and patient education.

Have you enjoyed the process of developing these videos?

This has been an amazing and exciting process, and truly demonstrates that motivation, teamwork and dedication can take an idea from the whiteboard into a real-life application. From my perspective, if we can show that our initiative has even the smallest, positive impact on blood product utilization, then we have accomplished our goal of striving for the best transfusion practice possible, and ultimately, doing what is right and best for patient care.

Through the BloodTechNet competition, Canadian Blood Services' Centre for Innovation funds innovative projects aimed at delivering educational tools and resources that support the development of skills, knowledge, and expertise of health professionals in the transfusion, cellular therapy, and transplantation communities in Canada.

Further reading

Social media for knowledge translation – a BloodTechNet project

The BloodTechNet Learning Fund was launched in 2011 by Canadian Blood Services’ Centre for Innovation. The BloodTechNet Competition, with support from Grifols, facilitates the development of innovative educational projects that support the Transfusion, Cellular Therapy and Transplantation communities in Canada.

Find out more about the educational resources developed through the BloodTechNet program.

Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration.

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.