Are ER Physicians 'Choosing Wisely'?
Many emergency physicians are performing low-value services, despite patients being deemed low-risk. The findings come from a cross-sectional sample survey of nearly 800 emergency physicians.
The survey sought to assess the impact the Choosing Wisely recommendations had, after the American College of Emergency Physicians (ACEP) decided to adopt the recommendations in 2013. The aim of the Choosing Wisely campaign is to reduce low-value tests and procedures, in order to improve value; currently healthcare spending per capita in the U.S. is the highest in the world.
The survey results showed that the most prevalent low-value practices were computed tomography (CT) brain for minor head injury (29.9%) and antibiotics for acute sinusitis (26.9%). Patient and family expectations was cited as the most important reason for providing antibiotics for sinusitis (68%), imaging for non-traumatic back pain (56.8%) and head CT after minor injury (40.8%). Concerns of serious diagnosis were cited as the reason for performing CT chest with normal D-dimer (49.7%), CT abdomen for recurrent uncomplicated renal colic (42.5%) and CT head after syncope (33.5%).
Fewer emergency physicians identified “reduce malpractice risk” as a primary reason for low-value services than “concern for serious diagnosis” or “patient or family expectations” across all recommendations.
A majority (62.9%) of respondents were able to identify at least 4 out of 5 recommendations. Sixty-four point five percent of respondents said they felt more comfortable discussing low-value services with patients as a result of the Choosing Wisely campaign. Additionally 54.5% reported reducing utilization due to Choosing Wisely.
With rates of emergency department advanced diagnostic imaging continuing to rise without evidence of improved outcomes, the author's state that greater efforts are needed to promote effective dissemination and implementation of Choosing Wisely, with such efforts possibly targeted based on differing reasons for low-value services.
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