Brandon Maughan, MD, recently published data from a survey of emergency department chairs and division chiefs at institutions with allopathic emergency medicine training programs. Of the 134 programs invited, 78 percent participated in the survey. Of those, 84 percent had heard of the Choosing Wisely campaign, while only 45 percent of the academic chairs had discussed this directly with patients, and approximately 50 percent could recall any of the ACEP recommendations.4
Explore This IssueACEP Now: Vol 35 – No 02 – February 2016
Put Choosing Wisely Into Practice
It’s time to make this campaign relevant by taking it to the bedside, benefiting both patients and providers. Avoiding unnecessary tests and treatments makes the emergency physician’s job easier while providing value-added service for the patient. However, patients may not recognize that “less is more” without education. To that end, shared decision making is an excellent tool that empowers the physician, through bedside education, to align patients’ desires for quality care with the payers’ interest in reducing cost and physicians’ interest in efficiency, achieving everyone’s goal for cost-effective care.
Many physicians struggle with how to introduce these recommendations into clinical practice. However, ACEP and the ABIM Foundation have developed resources to assist. ACEP has committed to translating the ideas of Choosing Wisely into action on several fronts. The recently launched ACEP Clinical Emergency Department Registry includes the development of five quality measures that enable emergency clinicians to report on the quality of imaging decisions to the Centers for Medicare and Medicaid Services for the Physician Quality Reporting System program. ACEP was recently awarded a Transforming Clinical Practice Initiative grant from the Centers for Medicare and Medicaid Innovation to launch a national learning collaborative supporting emergency departments and individual clinicians in implementing these Choosing Wisely recommendations. Under this grant, ACEP will also be offering new eCME modules and partnering with the American Board of Emergency Medicine to integrate more Choosing Wisely topics into the Lifelong Learning and Self-Assessment and Maintenance of Certification practice improvement activities list
Below are several steps that may be useful to incorporate Choosing Wisely into your practice. Let’s take ACEP’s Choosing Wisely recommendation #9 (below), prescribing antibiotics for uncomplicated sinusitis, for example. (It is available online at www.choosingwisely.org/clinician-lists/acep-antibiotics-in-the-ed-for-sinusitis.) Many patients expect to receive antibiotics for “sinusitis.” We have to educate them about their lack of efficacy and give them a reason to not want antibiotics.
Step 1: Plant the seed of your recommendation: “You know, you may not need antibiotics, and they could be harmful to you.”