About two years ago, William H. Sabina, MD, FACEP, Director of the Emergency Department and Chief of Emergency Medicine at South County Hospital in Rhode Island, noticed Choosing Wisely materials at the annual American College of Emergency Physicians (ACEP) meeting.
He didn’t just glance at them – he sat down and read more. And he began to see the campaign mentioned again and again on meeting agendas in other work he was involved with through The Rhode Island Quality Institute (RIQI) and TeamHealth.
“Emergency physicians sometimes don’t have a full history for a patient, so we are afraid we might be missing something,” Dr. Sabina said. “Choosing Wisely recommendations really focus on being able to eliminate risks. It is based on science and based on data—providing physicians with a guideline to look for red flags so they won’t miss anything. It is not new science, but it is presented in a different way.”
RIQI and the ACEP Emergency Quality Network (E-Qual) recently formed a statewide collaborative to implement Choosing Wisely recommendations about back pain across seven emergency departments. The goal of the collaborative, which is supported through the Centers for Medicare and Medicaid Services Transforming Clinical Practice Initiative (TCPI), is to reduce imaging for non-traumatic back pain in low-risk patients by 30 percent by December 2017.
During the first quarter of 2017, the collaborative gathered baseline data from chart reviews of patients with atraumatic back pain across each organization, and members will continue to monitor avoidable imaging and overall imaging rates. RIQI is now working with each emergency department to tailor interventions to reduce avoidable imaging, such as developing scripts for patient discussions and providing patients with Choosing Wisely resources developed by Consumer Reports, such as pamphlets and wallet cards.
“ACEP provides the clinical expertise and learning while RIQI provides materials, data collection and boots on the ground to put Choosing Wisely into practice,” said Karen Sax McLoughlin, ScM, Senior Director, Quality Improvement Initiatives for RIQI. “Just discussing the exposure to radiation from unnecessary imaging goes a long way with patients. Engaging physician leaders is a key factor to design interventions and garner organizational support.”
Dr. Sabina is one such leader and he is currently working with three of the TCPI sites to encourage clinicians to discuss imaging with patients, distribute Choosing Wisely wallet cards and track data.
“Personally, I have found that talking about imaging with patients opens up a conversation on chronic back pain,” Dr. Sabina said. “We can ask them what brought them in, what they need help with and discuss what options and treatments are available.”
Dr. Sabina and team also identified the need to take their work beyond emergency rooms, since primary care physicians sometimes send patients in for imaging. He and other physician leaders were invited to speak about the TCPI grant with a statewide group of primary care physicians.
“In my experience, this is not the usual in health care. I think we are all coming to the same conclusion that Choosing Wisely is a very big idea,” he said.