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Top 5 ED Procedures to Avoid

   February 18, 2014

A health system's emergency medicine clinicians, using a methodology based on consensus, has developed a list of services that can be avoided to prevent patient harm and reduce hospital costs.

Nearly 200 emergency clinicians at six Partners Healthcare hospitals near Boston have developed a list of five overused, low-value services—an alternative to the "Choosing Wisely" campaign's list. The difference: Partners' list was built with a consensus of doctors and mid-level practitioners on the front lines of emergency room care.

"The point was not so much to critique Choosing Wisely, which hadn't started when we began this project," explains Jeremiah Schuur, MD, Vice Chair of Patient Safety and Quality at Brigham and Women's Hospital's Department of Emergency Medicine.

Rather, he says, the point was "to develop a process that's transparent and that reflects actions a specialty provider [such as an emergency doctor] can make. We wanted to make sure this wasn't just experts in a room, but reflects what practicing providers thought."

Another component of the Partners list is that these are tests or services that not only have almost no value in defined low-risk patients who seek emergency care, but "we wanted to choose items the emergency physician largely has control over… can decide to order or not order," as opposed to tests or procedures that another provider in the hospital, such as a surgeon, may want done for their patients.


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