Step 2: Develop your 30-second monologue explaining Choosing Wisely. For example: “The campaign is designed to provide only valuable treatments for patients based on the current evidence from research. This also helps to avoid injury to patients from treatments they don’t need.”
Explore This IssueACEP Now: Vol 35 – No 02 – February 2016
Step 3: Select one of the seven supporting citations accompanying #9 to support your treatment recommendation. For example: Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, et al. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev. 2014;2:CD000243.
Step 4: Take one or two quotes from the article that suggest a lack of efficacy. For example, “There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis. However, about 80 percent of participants treated without antibiotics improved within two weeks.”
Step 5: Select one or two additional reasons the treatment may be harmful. For example:
- Antibiotic resistance is an issue. http://www.cdc.gov/drugresistance/
- Altering one’s individual microbiome may be harmful.
- Ursell LK, Metcalf JL, Parfrey LW, et al. Defining the human microbiome. Nutr Rev. 2012;70(Suppl 1):S38-S44.
Step 6: The safety zone: make a statement open to antibiotic use in the future but confirming you won’t be prescribing any today. For example: “Today it looks like you have a virus, which won’t respond to antibiotics. If you don’t get better, we can always use antibiotics at a later time, when it might be possible that you have a bacterial infection.”
Step 7: Confirm the patient is on board with the plan and document that in your medical record. If they’re still not on board, you may consider writing them a “wait-and-see prescription” (not to be filled unless their symptoms don’t improve by a certain date).
With a little preparation, we can all help translate the recommendations from the Choosing Wisely campaign into practice improvements.
Dr. Klauer is the chief medical officer–emergency medicine and chief risk officer for TeamHealth as well as the executive director of the TeamHealth Patient Safety Organization. He is an assistant clinical professor at Michigan State University College of Osteopathic Medicine and medical editor-in-chief of ACEP Now.
- Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the Choosing Wisely campaign. Acad Med. 2014;89:990-995.
- Rosenberg A, Agiro A, Gottlieb M, et al. Early trends among seven recommendations from the Choosing Wisely campaign. JAMA Intern Med. 2015;175:1913-1920. Brownson RC, Kreuter MW, Arrington BA, et al.
- Brownson RC, Kreuter MW, Arrington BA, et al.Translating scientific discoveries into public health action: how can schools of public health move us forward? Public Health Rep. 2006;121(1):97-103
- Maughan BC, Baren JM, Shea JA, et al. Choosing Wisely in emergency medicine: a national survey of emergency medicine academic chairs and division chiefs. Acad Emerg Med. 2015;22:1506-1510.