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Grassroots Efforts to Improve Patient Care


When it joined with 15 other medical specialty societies at a Feb. 21 press conference to announce updates to the ABIM Foundation’s Choosing Wisely campaign to combat cost and waste reduction in healthcare , SHM leaders said they hoped the hospitalist-focused quality guidelines would trickle down from the national level to clinicians in the field (see “Stop! Think Twice Before You Order"). The lists of treatments adult and pediatric hospitalists should consider questioning in the absence of evidence or protocols include the urinary catheters, blood transfusions, telemetry monitoring outside of the ICU, and certain lab tests and medications for preventing stress ulcers.

The Choosing Wisely campaign was a popular topic at HM13 in National Harbor, Md., with dozens of hospitalists attending a pre-course featuring lectures and small-group discussions, while a breakout session during the main meeting explored next steps for hospitalists committed to QI techniques and processes.

Ian Jenkins, MD, a hospitalist at the University of California, San Diego, who presented during both Choosing Wisely sessions, said hospitalists are at the intersection of healthcare cost and quality improvement. “People recognize the moral imperatives,” he said.

Pre-course participants split into four teams and drilled deeper into questionable treatments and practices outlined by the campaign. SHM plans to make results of those small-group discussions available to its members, along with enhanced reference lists and best practices from the field. “We can contribute a bunch of stuff,” Dr. Jenkins told pre-course participants. “Tell us what you can contribute, and what you’d like to see from us.”

Hospitalist George Dimitriou, MD, of Allegheny General Hospital in Pittsburgh, said his hospital has spent the past couple of years working on several of the same hospital-focused quality issues outlined in the Choosing Wisely campaign.

“Our transfusion initiative was driven by the local blood bank, knowing we were over-transfusing,” he said. “We had an order set, but we recently put in place a more restrictive transfusion policy, following national guidelines.

“Our Foley catheter protocol was in response to the national recommendations to reduce urinary tract infections, mostly driven by our infectious disease department,” Dr. Dimitriou added. The hospital has not yet tackled the problem of overuse of telemetry services, “although that’s something I have wanted to do for a long time.”

Another hot-button issue, the daily ordering of lab tests, should be rectified by simply “taking it out of the electronic medical record as a default option.”

According to SHM staff, a Choosing Wisely case study competition will be held next year, with $10,000 in cash prizes awarded for adult and pediatric quality initiatives showing improvement in utilization, innovation, sustainability, and institutional commitment. An independent review panel will develop evaluation criteria, with a projected application deadline of Fall 2014. The competition is supported by a $50,000 grant from the ABIM Foundation. TH

Larry Beresford is a freelance writer in Oakland, Calif.

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