Quality

Choosing Wisely in Hospital Medicine: Accomplishments and What the Future Holds


 

John Bulger, DO, MBA reviewed the components of the Choosing Wisely campaign and SHM’s recommendations in an era where providing high value cost-conscious care is key to optimizing the health of our patients. Choosing Wisely is an initiative of the ABIM foundation to foster communication between physicians and patients about common tests and procedures that may fail to provide value or enhance patient outcomes. It’s a partnership with 70-plus medical societies including an innovative partnership with Consumer Reports. SHM’s evidence-based recommendations are:

  • Don’t leave urinary catheters in place for convenience or monitoring of output for non-critically ill patients.
  • Don’t prescribe stress ulcer prophylaxis to hospitalized patients unless they are at high risk for GI complications.
  • Avoid transfusion of PRBC for arbitrary hemoglobin in the absence of CAD, CHF or CVA.
  • Don’t order continuous telemetry monitoring outside of the ICU without a protocol.
  • Don’t perform repetitive CBC and chemistry testing in a clinically stable patient.

Dr. Bulger highlighted that the Choosing Wisely campaign is designed to encourage conversations to

improve patient care. While cost-conscious care is a natural by-product of this effort, the primary focus when these guidelines were developed was to provide better healthcare for our patients. This year, SHM’s Choosing Wisely Case Competition has triggered the application of the above recommendations in institutions across the country. A summary of these efforts will be published in the near future to assist fellow hospitalists with their efforts to minimize waste and improve care in their own institutions. Look for the Hospitalist Guide to Choosing Wisely which is expected to be published in spring 2015. Choosing Wisely has now become a world-wide effort with Canada, Europe and Brazil implementing similar recommendations to improve healthcare.

Dr.Bulger concluded that while tradition is hard to change, it is of paramount importance to think differently to find innovative solutions to common problems in healthcare. Join the conversation using #ChoosingWisely or #LessIsMore on twitter.

Key Takeaways

  • Choosing Wisely is an ABIM campaign developed to address and promote conversations about common tests and procedures that are of low-value.
  • SHM’s recommendations were implemented in institutions with positive results as evidenced by the Choosing Wisely case competition at #HospMed15.
  • Look for a summary of these efforts to be published in the spring of 2015.
  • Use these guidelines to educate, provoke dialogue and achieve optimal patient outcomes in your institution.
  • Join the conversation on twitter using #ChoosingWisely and #LessIsMore.

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