Medical Minute: Choosing Wisely Campaign and ACEP

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August 20, 2014 by dailybolusoflr

By Julie Rice, MD
The Choosing Wisely Campaign is an initiative by the American Board of Internal Medicine to promote dialogue between physicians and their patients about appropriate tests and treatments, especially treatments where harm may outweigh benefits.  The ABIM partners with specialty societies to develop recommendations for that specialty.  This year ACEP joined the campaign and, with the help of a panel of ED expert physicians,  developed five recommendations for our specialty.
1.     Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules. 
·      If your patient’s history and physical exam does not concern you enough to get a CT scan, and they do not meet any criteria by commonly used decision rules, please don’t scan their head
·      You can use this recommendation in your conversation with the patient when they insist on a scan that you believe is unnecessary.

2.     Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience. 
·      We know they get UTIs, lets prevent our elderly patients from getting delirious just because we want strict I/O measurements

3.     Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.
·      Know your ED’s policy for getting palliative care involved
·      This is a big ticket item because earlier palliative care could mean less really expensive work ups (just because we don’t bring it up…ever)

4.     Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up. 

5.     Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children

·      Getting IVs can be difficult in children.  Try a PO trial in mild to moderate dehydration first. 

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