Strategies to Avoid 5 Highly Overused Treatments

Leigh Page

July 16, 2013

In This Article

Blood Transfusions

Some physicians use a great deal of blood for transfusions in surgery and to manage anemia, even though there is a growing array of alternative treatments. Recent studies have lowered the bar on how much blood is needed in an operation, according to Dr. Stream.

High use threatens to reduce the blood supply and also pose risks to patients. Dr. Stream said changes in blood-banking have greatly reduced the risk for infection, but there are still major risks with allergic or transfusion reactions. The panel reported that there were 6000 adverse reactions in 2008.

The panel found that medical students and residents get insufficient instruction in transfusion medicine.

Recommendations: Create a tool kit of clinical education materials for physicians, expand education on transfusion avoidance and appropriate alternatives to transfusion, and develop a separate informed consent process for transfusion that communicates the risks and benefits.

Ear Tubes for Children

Tympanostomy tubes are plastic grommets punched through a child's eardrum under general anesthetic to treat middle ear infections. Otolaryngologists implant more than 600,000 tubes in children, making this the most common surgery in the country, said Scott Schoem, MD, director of otolaryngology at Connecticut Children's Medical Center in Hartford.

Now, however, that new immunizations such as the pneumococcal vaccine (Prevnar, Wyeth) have decreased the number of serious infections, he said.

Nevertheless, Dr. Schoem noted that setting down the rules for use of ear tubes means dealing with a big gray area. "Recurring ear infections don't mean you need to have ear tubes, but ear tubes makes quality of life better and helps kids develop good speech skills," he said. The infection can affect children's hearing, which affects speech skills.

Recommendations: Devise performance measures for appropriate use of tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of shared decision-making with parents and other caregivers.

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