Background: A new update to the Choosing Wisely Campaign was released September 2019.
Study design: Expert consensus recommendations from the American Society for Clinical Pathology.
Synopsis: Eleven of the 30 Choosing Wisely recommendations directly affect hospital medicine. Half of these recommendations are related to infectious diseases. Highlights include:
- Not routinely using broad respiratory viral testing and instead using more targeted approaches to respiratory pathogen tests (e.g., respiratory syncytial virus, influenza A/B, or group A pharyngitis) unless the results will lead to changes to or discontinuations of antimicrobial therapy or isolation.
- Not routinely testing for community gastrointestinal pathogens in patients that develop diarrhea 3 days after hospitalization and to primarily test for Clostridiodes difficile in these patients, unless they are immunocompromised or older adults.
- Not checking procalcitonin unless a specific evidence-based guideline is used for antibiotic stewardship, as it is often used incorrectly without benefit to the patient.
- Not ordering serology for Helicobacter pylori and instead ordering the stool antigen or breath test to test for active infection given higher sensitivity and specificity.
- Not repeating antibody tests for patients with history of hepatitis C and instead ordering a viral load if there is concern for reinfection.
Bottom line: Only order infectious disease tests that will guide changes in clinical management.
Citation: ASCP Effective Test Utilization Steering Committee..
Dr. Blount is clinical instructor of medicine, hospital medicine, at the Rocky Mountain Veterans Affairs Regional Medical Center, Aurora, Colo.