Tags: needless | medical | procedures | unnecessary | choosing | wisely

Medical Group Spotlights Needless Medical Tests, Procedures

By Nick Tate   |   Wednesday, 21 Aug 2013 04:34 PM

Medical experts estimate up to 20 percent of healthcare spending goes for wasteful or unnecessary procedures. To combat the issue, several medical organizations are participating in a campaign to spotlight wasteful or even harmful medical procedures in an effort to raise patients' and doctors' awareness.
A new study published the Journal of Hospital Medicine spotlights 10 common procedures that a number of national medical societies have deemed sometimes unnecessary — tests, therapies, or procedures that patients and physicians should question and discuss. The organizations have joined the so-called Choosing Wisely campaign created last year.

The new recommendations were published jointly by the American Board of Internal Medicine Foundation and the Society of Hospital Medicine.
The top five recommendations for pediatricians treating hospitalized children:
  • Don't order chest radiographs in children with asthma or bronchiolitis. This can decrease costs, reduce radiation exposure, and minimize the overuse of antibiotics due to false positive results.
  • Don't use bronchodilators in children with bronchiolitis because the agents have minimal benefits.
  • Don't use systemic corticosteroids in children under two years of age with a lower respiratory tract infection because the treatment is potentially harmful and provides little or no benefit.
  • Don't treat gastroesophageal reflux in infants with acid suppression therapy, such as proton pump inhibitors, which are not effective may cause side effects in newborns.
  • Don't use continuous pulse oximetry — a method for measuring oxygen saturation in the blood —in children with acute respiratory illness unless they are on supplemental oxygen.
"If pediatricians around the country adopt and follow these recommendations, the savings to our healthcare system could be in the millions, given the large number of hospitalized children this would affect," said lead researcher Ricardo Quinonez, M.D., with of the Children's Hospital of San Antonio and Baylor College of Medicine.
Researchers also outlined five recommendations adopted by the Society of Hospital Medicine regarding the care of adults:
  • Do not place, or leave in place, urinary catheters for incontinence in non-critically ill patients.
  • Do not prescribe medications to prevent stress ulcers in medical inpatients unless they are at high risk for gastrointestinal complications.
  • 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.
  • Do not order continuous telemetry monitoring outside of the intensive care unit.
  • Do not perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability.
"These [pediatric and adult] lists are good starting points, and in fact many hospitalist groups, including our own, are using the Society of Hospital Medicine practices as a foundation for our waste reduction efforts," said Andrew Auerbach, M.D., MPH, and Robert Wachter, M.D., of the University of California-San Francsico, in an accompanying editorial. "The next challenge will be translating these recommendations into actionable measures and then clinical practice."

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