The Society of Hospital Medicine’s “Choosing Wisely” Recommendations for Hospitalists
SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question (see below). Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.
Adult Hospitalist “Avoid List”
1. Do not place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for non-critically ill patients (acceptable indications: critical illness, obstruction, hospice, perioperatively for <2 days for urologic procedures; use weights instead to monitor diuresis).
2. Do not prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications.
3. Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms or active coronary disease, heart failure or stroke.
4. Do not order continuous telemetry monitoring outside of the ICU without using a protocol that governs continuation.
5. Do not perform repetitive CBC and chemistry testing in the face of clinical and lab stability.
Pediatric HospitalIST “Avoid List”
1. Don’t order chest radiographs in children with uncomplicated asthma or bronchiolitis.
2. Don’t routinely use bronchodilators in children with bronchiolitis.
3. Don’t use systemic corticosteroids in children under 2 years of age with an uncomplicated lower respiratory tract infection.
4. Don’t treat gastroesophageal reflux in infants routinely with acid suppression therapy.
5. Don’t use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen.
