Choosing wisely in pediatric hospital medicine: Five opportunities for improved healthcare value
Corresponding Author
Ricardo A. Quinonez MD
Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, Texas
Address for correspondence and reprint requests: Ricardo A. Quinonez, MD, Associate Professor of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St., Suite A210, Houston, TX 77030; Telephone: 713-240-7908; Fax: 832–825–5424; E-mail: [email protected]Search for more papers by this authorMatthew D. Garber MD
Division of General and Hospital Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
Search for more papers by this authorAlan R. Schroeder MD
Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
Search for more papers by this authorBrian K. Alverson MD
Department of Pediatrics, Hasbro Children's Hospital, Brown University, Providence, Rhode Island
Search for more papers by this authorWendy Nickel MPH
Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorJenna Goldstein MA
Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorJeffrey S. Bennett MD
Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
Search for more papers by this authorBryan R. Fine MD, MPH
Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia
Search for more papers by this authorTimothy H. Hartzog MD
Division of General Pediatrics, Medical University of South Carolina, Charleston, South Carolina
Search for more papers by this authorHeather S. McLean MD
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
Search for more papers by this authorVineeta Mittal MD
Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Texas
Search for more papers by this authorRita M. Pappas MD
Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Search for more papers by this authorJack M. Percelay MD, MPH
E. L. M. O Pediatrics, New York, New York
Search for more papers by this authorShannon C. Phillips MD, MPH
Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Search for more papers by this authorShawn L. Ralston MD
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Search for more papers by this authorCorresponding Author
Ricardo A. Quinonez MD
Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, Texas
Address for correspondence and reprint requests: Ricardo A. Quinonez, MD, Associate Professor of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St., Suite A210, Houston, TX 77030; Telephone: 713-240-7908; Fax: 832–825–5424; E-mail: [email protected]Search for more papers by this authorMatthew D. Garber MD
Division of General and Hospital Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
Search for more papers by this authorAlan R. Schroeder MD
Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
Search for more papers by this authorBrian K. Alverson MD
Department of Pediatrics, Hasbro Children's Hospital, Brown University, Providence, Rhode Island
Search for more papers by this authorWendy Nickel MPH
Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorJenna Goldstein MA
Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorJeffrey S. Bennett MD
Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
Search for more papers by this authorBryan R. Fine MD, MPH
Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia
Search for more papers by this authorTimothy H. Hartzog MD
Division of General Pediatrics, Medical University of South Carolina, Charleston, South Carolina
Search for more papers by this authorHeather S. McLean MD
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
Search for more papers by this authorVineeta Mittal MD
Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Texas
Search for more papers by this authorRita M. Pappas MD
Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Search for more papers by this authorJack M. Percelay MD, MPH
E. L. M. O Pediatrics, New York, New York
Search for more papers by this authorShannon C. Phillips MD, MPH
Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Search for more papers by this authorShawn L. Ralston MD
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Search for more papers by this authorAbstract
BACKGROUND
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 workgroup's results.
METHODS
A workgroup 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.
RESULTS
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.
CONCLUSION
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. Journal of Hospital Medicine 2013;8:479–485. © 2013 Society of Hospital Medicine
Supporting Information
Additional Supporting Information may be found in the online version of this article.
| Filename | Description |
|---|---|
| jhm2064-sup-0001-suppinfo.docx11.1 KB | Supplementary Informationarticle. |
| jhm2064-sup-0002-suppinfoTable01.docx15 KB | Supplementary Information Table 1 |
| jhm2064-sup-0003-suppinfoTable02.docx19.3 KB | Supplementary Information Table 2 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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