Volume 8, Issue 9 p. 486-492
Original Research

Choosing wisely in adult hospital medicine: Five opportunities for improved healthcare value

John Bulger DO, MBA

Corresponding Author

John Bulger DO, MBA

Division of Quality and Safety, Geisinger Health System, Danville, Pennsylvania

Address for correspondence and reprint requests: John Bulger, DO, Chief Quality Officer, Geisinger Health System, 100 N Academy Ave., Mail Code 30-08, Danville, PA 17822; Telephone: 570-214-7020; Fax: 570-271-5518; E-mail: [email protected]Search for more papers by this author
Wendy Nickel MPH

Wendy Nickel MPH

Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania

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Jordan Messler MD

Jordan Messler MD

Morton Plant Hospitalists, In Compass Health, Clearwater, Florida

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Jenna Goldstein MA

Jenna Goldstein MA

Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania

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James O'Callaghan MD

James O'Callaghan MD

Division of Hospital Medicine, Seattle Children's Hospital, Seattle, Washington

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Moises Auron MD

Moises Auron MD

Department of Hospital Medicine and Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, Ohio

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Mangla Gulati MD

Mangla Gulati MD

Department of Clinical Effectiveness, University of Maryland Medical Center, Baltimore, Maryland

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First published: 19 August 2013
Citations: 114

Abstract

BACKGROUND

In an effort to lead physicians in addressing the problem of overuse of medical tests and treatments, the American Board of Internal Medicine Foundation developed the Choosing Wisely campaign. The Society of Hospital Medicine (SHM) joined the initiative to highlight the need to critically appraise resource utilization in hospitals.

METHODS

The SHM employed a staged methodology to develop the adult Choosing Wisely list. This included surveys of the organization's leaders and general membership, a review of the literature, and Delphi panel voting.

RESULTS

The 5 recommendations that were subsequently approved by the SHM Board are: (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 gastrointestinal 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 intensive care unit without using a protocol that governs continuation. (5) Do not perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability.

CONCLUSIONS

Hospitalists have many opportunities to impact overutilization of care. The adult hospital medicine Choosing Wisely recommendations offer an explicit starting point for eliminating waste in the hospital. Journal of Hospital Medicine 2013;8:486–492. © 2013 Society of Hospital Medicine