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

Ricardo A. Quinonez, Matthew D. Garber, Alan R. Schroeder, Brian K. Alverson, Wendy Nickel, Jenna Goldstein, Jeffrey S. Bennett, Bryan R. Fine, Timothy H. Hartzog, Heather S. Mclean, Vineeta Mittal, Rita M. Pappas, Jack M. Percelay, Shannon C. Phillips, Mark Shen, Shawn L. Ralston

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)479-485
Number of pages7
JournalJournal of Hospital Medicine
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 2013

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ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Quinonez, R. A., Garber, M. D., Schroeder, A. R., Alverson, B. K., Nickel, W., Goldstein, J., ... Ralston, S. L. (2013). Choosing wisely in pediatric hospital medicine: Five opportunities for improved healthcare value. Journal of Hospital Medicine, 8(9), 479-485. https://doi.org/10.1002/jhm.2064