Choosing Wisely

Interesting article published last week with 10 recommendations for hospitalists (applies to internal medicine residents as well!) to help provide high-quality, cost-conscious care. Take a look at the summary below before heading to the actual article:


1. From the American Gastroenterological Association (say that 5 times, fast!): For a patient with functional abdominal pain syndrome (as per Rome criteria), computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

2. From the American College of Rheumatology (ACR): Don’t test anti-nuclear antibody (ANA) sub-serologies without a positive ANA and clinical suspicion of immune-mediated disease.

3. From the American College of Physicians (ACP): In patients with low pretest probability of venous thromboembolism (VTE), obtain a high-sensitive D-dimer measurement as the initial diagnostic test; don’t obtain imaging studies as the initial diagnostic test.

4. From the American Geriatrics Society (AGS): Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

5. From the American Society of Echocardiography (ASE): Avoid echocardiograms for pre-operative/peri-operative assessment of patients with no history or symptoms of heart disease.

6. From the American Society of Nephrology (ASN): Do not place peripherally inserted central venous catheters (PICC) in stage three to five chronic kidney disease (CKD) patients without consulting nephrology.

7. From the Society of Thoracic Surgery (STS): Patients who have no cardiac history and good functional status do not require pre-operative stress testing prior to noncardiac thoracic surgery.

8. From the Society of Nuclear Medicine and Molecular Imaging (SNMMI): Avoid using a CT angiogram to diagnose PE in young women with a normal chest radiograph; consider a radionuclide lung (V/Q) study instead.

9. From the American Academy of Pediatrics (AAP): Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).

10. From the American College of Obstetrics and Gynecology (ACOG): Don’t schedule elective inductions prior to 39 weeks, and don’t schedule elective inductions of labor after 39 weeks without a favorable cervix.

The Hospitalist. 2014;18(6):1,12-14