Dr. David Zodda and his team at Hackensack University Medical and Trauma Center, including Drs. Kevin Hewitt, Sean Pierce, Douglas Finefrock, Gregory Nicola, Gabrielle Procopio and Jennifer Artick, won the 2017 Choosing Wisely Champions group award from the American College of Emergency Physicians (ACEP).
The Choosing Wisely Champions program is designed to recognize clinicians who have gone above and beyond to make significant contributions to advance the ideals of the Choosing Wisely campaign by working to reduce overuse and unnecessary tests and treatments in medicine.
The team at Hackensack worked for the last two years to design and implement a series of institutional paradigms based on Choosing Wisely recommendations, including one focused on appropriate spine imaging. They worked with cross-specialty teams to educate clinicians from across the institution about evidence-based care.
The “We’ve Got Your Back” paradigm was designed with input from multiple medical specialties such as radiology, emergency medicine, pain management, nursing and orthopedic surgery to promote appropriate lumbar spine imaging in the emergency department (ED) for adults with non‐traumatic back pain.
The team developed a clinical protocol for the evaluation of non-traumatic back pain in the ED, which stratifies patients into three pathways (Green, Amber, Red). Each pathway includes evidence‐based recommendations regarding imaging and medications.
“We thought, ‘how can we get the right people on board’ and ‘how can we lay out the right treatment options’?” Dr. Zodda said. “We engaged physicians and clinicians from across the system to take a 360-degree look at back pain. We trained everyone on what red flags to look for if patients had back pain and if there were no red flags. We train the team not to provide imaging, opioids or lab work. We then established a process to re-evaluate patients as needed and got buy-in from spine specialists to offer a free visit within seven days if pain persisted.”
Dr. Zodda said that the paradigm was successful, but it was challenging to calculate results. The team is now in the process of re-introducing the paradigm with the goal of gathering pre-intervention and post-intervention data. This time, in addition to the risk stratification tools, the team wants to make Choosing Wisely information available to promote shared-decision making by the bedside.
“We feel really fortunate to be selected as Choosing Wisely Champions,” Dr. Zodda said. “It’s a testament to our institution. We have buy-in from chairs of multiple departments and to be formally recognized at the patient safety meeting at ACEP was amazing.” You can follow Dr. Zodda on Twitter at @ElevateMedicine.
Additional ACEP Choosing Wisely Champions include:
Individual Winner: Dr. Mark Baker, MD, FACEP, of Hawaii Pacific Health System, supported joining Choosing Wisely at the 2012 ACEP Council meeting. Since then, he has distributed ACEP Choosing Wisely recommendations to ED physicians in the four‐hospital Hawaii Pacific Health system and promoted incorporation of recommendations into the system’s electronic health record. He expanded the concept of Choosing Wisely to “Clinical Effectiveness” and has proposed an ACEP Clinical Effectiveness Committee to identify, assess and promote evidence‐based care. Read a previous interview with Dr. Baker.
Resident winner: Dr. Christina Creel‐Bulos, MD, of Washington University in St. Louis, is a third-year resident with a passion for critical care and palliative care. She completed research on initiating palliative care in the ED, led resident and nursing education sessions focused on the topic and published an article on the subject in the Missouri ACEP online newsletter. In May, Dr. Creel was selected to speak at the Lown Institute annual conference, and her research won an Audience Choice Award.