A top-five list of emergency medicine procedures that are of low value and could help control costs if providers do not order them was developed as part of a study by Jeremiah D. Schuur, M.D., M.H.S., of Brigham and Women’s Hospital, Boston, and colleagues.
The cost of medical care in the United States is growing at an unsustainable rate and the tests, treatments and hospitalizations that come from emergency department care are expensive, according to the study background.
The authors assembled an expert panel to develop a top-five list of tests, treatments and other triage decisions that are of little value and actionable (within the control) of emergency medicine clinicians. The top-five list recommends that emergency physicians:
- Do not order computed tomography (CT) of the cervical spine for patients after trauma who do not meet high-risk criteria.
- Do not order CT to diagnose pulmonary embolism (blockage of an artery in the lung usually by a blood clot) without first determining a patient’s risk for pulmonary embolism.
- Do not order magnetic resonance imaging (MRI) of the lumbar spine for patients with lower back pain without high-risk features.
- Do not order CT of the head for patients with mild traumatic head injury who do not meet high-risk criteria.
- Do not order anticoagulation studies for patients without hemorrhage or suspected clotting disorder.
“Emergency medicine is under immense pressure to improve the value of health care services delivered. … Our project piloted a method that EDs (emergency departments) can use to identify actionable targets of overuse; we identified clinical actions that were of low value, within clinician control, and for which consensus existed among ED health care clinicians. Developing and addressing a top-five list is a first step to addressing the critical issue of the value of emergency care,” the study concludes.
JAMA Intern Med. Published online February 10, 2014. doi:10.1001/jamainternmed.2013.12688.
This study was supported by an Emergency Medicine Residents’ Association student research grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.