Continual improvement of safe, effective care delivery is a goal of every clinician. Involving our patients in shared decision making and discussing the value of low-yield testing and therapeutics is a fundamental ethical responsibility. The Choosing Wisely campaign, launched by the American Board of Internal Medicine in 2012, aims to publicize and engage clinicians and patients in support of such discussions.1
Whether this list, or any of the Choosing Wisely recommendations, meets your expectations as representing the “low-hanging fruit” of low-yield care in your clinical setting, these efforts illuminate important cultural changes.
The initiative spans more than 30 specialties, including emergency medicine, and ACEP announced its first five recommendations at ACEP13 in Seattle. These recommendations, covered previously by ACEP Now, address imaging in minor head injury, urinary catheter placement, palliative and hospice care, abscess management, and fluid administration.2 However, many other specialties have produced recommendations for care of patients within their purview that have substantial overlap with the spectrum of care provided in the emergency department. Here are a few of the highlights from across the rest of the medical community:
American Academy of Allergy, Asthma & Immunology
Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
This very broad recommendation is supported in part by those from the American Academy of Family Physicians, the American Academy of Otolaryngology–Head and Neck Surgery, and the American Academy of Pediatrics. Acute, uncomplicated sinusitis rarely benefits from antibiotic therapy, and the population costs and harms from excessive antibiotic prescribing are undeniable.
American Academy of Family Physicians
Don’t prescribe antibiotics for otitis media in children ages 2–12 years with nonsevere symptoms where the observation option is reasonable.
This is another recommendation, supported by recent American Academy of Pediatrics guidelines, aimed at reducing unnecessary antibiotic overuse.3 Otitis media is nearly universally a self-limited condition, and the observed relative curative benefit of antibiotics is counterbalanced by antibiotic-associated diarrhea and other adverse drug events.4
American Academy of Ophthalmology
Don’t order antibiotics for adenoviral conjunctivitis (pink eye).
Pink eye is contagious, unsightly, and uncomfortable—but typically clinically apparent as a local viral process for which antibiotics are not appropriate or beneficial.
American Academy of Pediatrics
CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.