Right-Sizing Care: Lessons for Pediatrics

Laurie Scudder, DNP, NP


June 01, 2016

Reducing Unnecessary Use

Medscape: Do you think such efforts as Choosing Wisely® have contributed to a reduction in unnecessary use?

Dr Schroeder: That's hard to know. However, a decrease in CT over the past 5 or 10 years is probably driven by better guidelines regarding appropriate imaging, as well as advocacy campaigns, such as Image Gently® and Image Wisely®.

Medscape: What strategies for reducing use of unnecessary tests and treatments in children were discussed at Lown—and what is the evidence for their efficacy?

Dr Quinonez: The Quality Improvement Innovation Networks, which is an effort led by the American Academy of Pediatrics, have examined local projects that have shown significant gains in decreasing overuse, particularly in bronchiolitis.[8] And they have tackled several other important areas of concern in both inpatient and outpatient settings.

To my mind, the important result of such efforts as Choosing Wisely is that they have inspired change at the local level, where it needs to happen. I know of one institution that specifically pointed to the recommendation to decrease use of continuous pulse oximetry from the pediatric section of the Society of Hospital Medicine's Choosing Wisely list[9] to develop a quality improvement project at their institution, with a goal of decreasing use. The investigators in a large children's hospital significantly reduced the use of pulse oximetry in children admitted to the hospital for wheezing, without any appreciable harm. Significant reductions of unnecessary care can be made, but it has to be through local quality improvement initiatives that drive improvement from the ground up.


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