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Shaun Frost: Society of Hospital Medicine Supports the Choosing Wisely Campaign (CWC)

The CWC anticipates publishing SHM’s list in February 2013. In the meantime, please consult the CWC website to find practices commonly performed by hospitalists that have been deemed to be of unclear benefit by other professional medical societies (see “2012 CWC Recommendations for Hospitalists,” left).

SHM plans to build upon this work in the future. Expect to see Choosing Wisely sessions and discussions at the HM13 SHM Annual Meeting in May (www.hospitalmedicine2013.org) focused on creating and teaching QI strategies to implement CWC recommendations. Furthermore, the Center for Hospital Innovation and Improvement will be identifying opportunities to develop mentored implementation QI programs related to Choosing Wisely and its principles.

What You Can Do

Hospitalists can make a huge impact on affordability and patient experience given that most of the country’s healthcare dollar is spent in the hospital, and patients are at their most vulnerable to receiving treatment that they may not want when they are acutely ill. Hospitalists, thus, are uniquely positioned to make a positive impact by embracing the Choosing Wisely Campaign’s principles.

Please commit to assisting SHM by visiting the CWC website and learning about other medical society’s thoughts on “things physicians and patients should question.” Pledge thereafter to engage your patients and their families in healthcare decision-making, especially in situations where the benefits of tests and therapies are unclear.

Attention to care affordability and experience are essential to reforming our broken healthcare system, so let’s lead the charge in these areas and help others who are doing the same.

Dr. Frost is president of SHM.

2012 CHoosing Wisely campaign Recommendations Hospitalists Need to know about1

  • Don’t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non cardiac surgery.
  • Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology;
  • In the evaluation of simple syncope and a normal neurological examination, don’t obtain brain imaging studies (CT or MRI).
  • In patients with low pretest probability of venous thromboembolism (VTE), obtain a high sensitive D-dimer measurement as the initial diagnostic test; don’t obtain imaging studies as the initial diagnostic test. Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with
  • hypertension or heart failure or CKD of all causes, including diabetes.
  • Don’t administer erythropoiesis-stimulating agents (ESAs) to chronic kidney disease (CKD) patients with hemoglobin levels greater than or equal to 10g/dL without symptoms of anemia.
  • Don’t place peripherally inserted central catheters (PICC) in stage III-IV CKD patients without consulting nephrology.
  • Don’t initiate chronic dialysis without ensuring a shared decision making process between patients, their families, and their physicians.
  • Don’t do imaging for uncomplicated headache.
  • Don’t obtain imaging studies in patients with non-specific low back pain;
  • Don’t recommend follow-up imaging for clinically inconsequential adnexal cysts.
  • Don’t use white cell stimulating
  • factors for primary prevention of febrile neutropenia for patients with less than 20 percent risk for this complication.
  • For a patient with functional abdominal pain syndrome (as per ROME III criteria) computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

SHM will publish its list of recommendations in February. View all the recommendations from specialty societies taking part in Choosing Wisely.

References

  1. The ABIM Foundation. Choosing Wisely: An initiative of the ABIM Foundation. Choosing Wisely website. Available at: http://www.choosingwisely.org. Accessed Sept. 25, 2012.
  2. The ABIM Foundation. Principles Guiding Wise Choices. ABIM Foundation website. Available at: www.abimfoundation.org/Initiatives/~/media/Files/2011-Forum/110411_ABIM%20Stewardship.ashx. Accessed Sept. 25, 2012.
  3. ABIM Foundation, ACP–ASIM Foundation, European Federation of Internal Medicine. Medical Professionalism in the New Millennium: A Physician Charter. Ann Intern Med. 2002;136(3):243.
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