Choosing wisely in pediatric hospital medicine: five opportunities for improved healthcare value

Despite estimates that waste constitutes up to 20% of healthcare expenditures in the United States, overuse of tests and therapies is significantly under-recognized in medicine, particularly in pediatrics. The American Board of Internal Medicine Foundation developed the Choosing Wisely campaign, whi...

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Vydáno v:Journal of hospital medicine Ročník 8; číslo 9; s. 479
Hlavní autoři: Quinonez, Ricardo A, Garber, Matthew D, Schroeder, Alan R, Alverson, Brian K, Nickel, Wendy, Goldstein, Jenna, Bennett, Jeffrey S, Fine, Bryan R, Hartzog, Timothy H, McLean, Heather S, Mittal, Vineeta, Pappas, Rita M, Percelay, Jack M, Phillips, Shannon C, Shen, Mark, Ralston, Shawn L
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.09.2013
Témata:
Choice Behavior
Hospital Medicine - methods
Hospital Medicine - standards
Hospitalists - standards
Hospitals, Pediatric - standards
Humans
Practice Guidelines as Topic - standards
Quality of Health Care - standards
Societies, Medical - standards
United States
United States
ISSN:1553-5606, 1553-5606
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Shrnutí:Despite estimates that waste constitutes up to 20% of healthcare expenditures in the United States, overuse of tests and therapies is significantly under-recognized in medicine, particularly in pediatrics. The American Board of Internal Medicine Foundation developed the Choosing Wisely campaign, which challenged medical societies to develop a list of 5 things physicians and patients should question. The Society of Hospital Medicine (SHM) joined this effort in the spring of 2012. This report provides the pediatric work group's results. A work group of experienced and geographically dispersed pediatric hospitalists was convened by the Quality and Safety Committee of the SHM. This group developed an initial list of 20 recommendations, which was pared down through a modified Delphi process to the final 5 listed below. The top 5 recommendations proposed for pediatric hospital medicine are: (1) Do not order chest radiographs in children with asthma or bronchiolitis. (2) Do not use systemic corticosteroids in children under 2 years of age with a lower respiratory tract infection. (3) Do not use bronchodilators in children with bronchiolitis. (4) Do not treat gastroesophageal reflux in infants routinely with acid suppression therapy. (5) Do not use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen. We recommend that pediatric hospitalists use this list to prioritize quality improvement efforts and include issues of waste and overuse in their efforts to improve patient care.
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ISSN:1553-5606
1553-5606
DOI:10.1002/jhm.2064