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

Journal Article (Journal Article;Review)

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 work group's results. METHODS: A work group 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.

Full Text

Duke Authors

Cited Authors

  • Quinonez, RA; Garber, MD; Schroeder, AR; Alverson, BK; Nickel, W; Goldstein, J; Bennett, JS; Fine, BR; Hartzog, TH; McLean, HS; Mittal, V; Pappas, RM; Percelay, JM; Phillips, SC; Shen, M; Ralston, SL

Published Date

  • September 2013

Published In

Volume / Issue

  • 8 / 9

Start / End Page

  • 479 - 485

PubMed ID

  • 23955837

Electronic International Standard Serial Number (EISSN)

  • 1553-5606

Digital Object Identifier (DOI)

  • 10.1002/jhm.2064


  • eng

Conference Location

  • United States