February 2020 Learning Network Resources

Tuesday, March 17th at 4:00PM EST
Join us for our March webinar where speaker Dr. Howard Beckman, Clinical Professor and Gerontologist from University of Rochester School of Medicine and Dentistry, will discuss providing clinician feedback, specifically having difficult conversations with clinicians on variation in practice.

Watch a recording of this Webinar.

National Sleep Awareness Week
March 1st – 8th is National Sleep Awareness Week. Check out Choosing Wisely’s Sleep Medicine Clinician Lists.

Blogs, Issue Briefs, Opinion Pieces and More…

  • A Successful but Underused Strategy for Reducing Low-Value Care: Stop Paying for It. JAMA Internal Medicine. February 2020
    “Waste in the United States health care system owing to overtreatment or low-value care is estimated at $75.7 billion to $101.2 billion. These estimates are likely a fraction of the actual spending because “tests beget tests” and often unnecessary procedures. Thus, patients are placed at significant risk associated with low-value care, with harms including increased anxiety, wasted time, missed work, and serious injury or death from treatment, with little or no chance of benefit.”
     
  • Study Finds Opioids and Imaging Tests Given Too Often for Low Back Pain. Pain News Network. January 2020
    “Lower back pain is the world’s leading cause of disability. Over 80 percent of us suffer acute low back pain at least once in our lives. A guideline released by the American College of Physicians in 2017 strongly recommend that physicians treat acute low back pain with exercise and other non-pharmacological therapies. If medication is used, the guideline recommends NSAIDs or muscle relaxers. Opioids are only recommended for patients with chronic back pain who have failed at other treatments.”
     

Journals

  • Swart N, Morris S, Murphy MF. Economic value of clinical decision support allied to direct data feedback to clinicians: blood usage in haematology. VoxSanguinis. February 2020
    “An electronic blood‐ordering system with clinical decision support can reduce blood transfusions and associated healthcare costs. Focusing on improving junior doctors’ transfusion practice is expected to have a knock‐on benefit in terms of dissemination of good transfusion practice both within their own department and others as they continue their training.”
     
  • Bourgault AM.Maximize Valuable Nursing Time by Eliminating or Reducing “Stupid Stuff.” Critical Care Nurse. February 2020
    “As we look for opportunities to get rid of the ‘stupid stuff,’ we may find free time that can be spent on important initiatives that can improve patient outcomes, including hourly rounding and patient-centered communication such as bedside shift report. We do not have time to keep adding practices into our busy schedules. We need to work smart and incorporate practices that make a difference for patient safety, quality, and (human connection) experience of care.”
     
  • Tran AV, Rushakoff RJ, Prasad P, Murray SG, Monash B, Macmaster H. Decreasing Hypoglycemia following Insulin Administration for Inpatient Hyperkalemia. Journal of Hospital Medicine. February 2020
    “The aims of this study were to accurately determine the frequency of iatrogenic hypoglycemia following insulin treatment for hyperkalemia, and to develop an electronic health record (EHR) orderset to decrease the risk for iatrogenic hypoglycemia. The use of an EHR orderset for treating hyperkalemia may reduce the risk of iatrogenic hypoglycemia in patients receiving insulin while still adequately lowering their potassium. The use of an EHR orderset for treating hyperkalemia may reduce the risk of iatrogenic hypoglycemia in patients receiving insulin while still adequately lowering their potassium.”
     
  • Ganguli I, Shi Z, Orav J, Rao A, Ray KN, Mehrotra A. Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008–2016. Annals of Internal Medicine. February 2020
    “Commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.”
     
  • Jimenez JDJM, Willaims K, Valencia B.Choosing Wisely: Decreasing the Use of Central Venous Catheters in Donors and Select Patients Undergoing Apheresis. January 2020
    “The use of PVA during apheresis procedures can be successful in a majority of patients. There is a decreased risk of complications associated with PVA vs central access, reduction in the impact on Interventional Radiology resources, time savings, as well as a significant cost savings for the patient and the organization.”
     
  • Pourjabbar S, Cavallo JJ, Arango J, Tocino I, Staib LH, Imanzadeh A, Forman HP, Pahade JK. Impact of Radiologist-Driven Change-Order Requests on Outpatient CT and MRI Examinations. Journal of the American College of Radiology. January 2020
    “Outpatient CT and MRI orders are deemed incorrect in 2.9% to 5% of cases. Radiologist-driven change-order request for CT and MRI are well accepted by ordering providers and decrease radiation exposure associated with imaging.”
     

Media

  • For Kid’s Coughs, Swap The Over-The-Counter Syrups For Honey. NPR. February 2020
    “What the studies have shown is that — for some reason — in kids they aren’t that effective. Plus, these drugs can cause side effects, such as increasing your blood pressure, making your heart rate go up or suppressing the drive to breathe — and that’s definitely something we don’t want for kids.”
     
  • What can doctors do for your back pain? Not as much as you can. The Guardian. February 2020
    “There is an unmistakable need for doctors to do better but, ultimately, doctors cannot help patients who won’t believe them. It might seem like anathema in this transactional world of modern medicine, but patients must recognize that the most effective long-term management of their back pain rarely belongs in the hands of doctors and that their suffering is far more likely to respond to graduated exercise, weight loss and a realignment of expectations. Admittedly, doctors don’t excel at giving such advice; patients don’t excel at taking it, but in view of the enormous individual and societal cost of back pain, sitting still, figuratively and literally, is not an option.”
     
  • Low-value services’ prevalence varies across regions. Modern Healthcare. February 2020
    “Residents who live in the north and southeast are more likely to receive a low-value healthcare service than those living in western and Midwestern states, according to a new analysis. The report, published by researchers at consultancy Altarum and funded by the PhRMA Foundation, found that about 20% of members of a large national insurer living in Florida, New Jersey, North Carolina and New York received at least one low-value service in 2015 while roughly 10% of the insurer’s members living in Alaska, North Dakota, Utah and Oregon experienced a low-value service. Low-value services included imaging for low back pain, routine cervical cancer screening and opioids for headache treatment.”
     
  • VA launches diabetes campaign to help Veterans, health care teams better manage care. The Southern Maryland Chronicle. January 2020
    “The U.S. Department of Veterans Affairs (VA) launched a new campaign this month to give Veterans a better understanding of their diabetes numbers, which are critical to their well-being. The Understand Your Diabetes Numbers campaign educates Veterans and their families on hemoglobin A1C, glucose meter, blood pressure, and kidney tests, and other vital measurements. VA’s diabetes campaign is guided by Choosing Wisely® which is a collective effort among professional societies whose goal is to reduce medical tests, treatments and procedures that may be unnecessary.”
     
  • Column: Low-value medical tests are costly, can lead to harm. Chicago Tribune. January 2020
    “So what should patients do? If you have a medical abnormality that is in the gray area, it’s hard to leave it alone. Anxiety often drives the cascade. Still, patients in that situation need to ask a lot of questions about why further testing or medical procedures are necessary and whether more information would tell a doctor something new. Patients need to understand up front what the consequences might be.”