Hospitalized Kids: First, Do No Harm
Hospitalized Kids: First, Do No Harm
Editor's Note:
The Choosing Wisely® initiative of the American Board of Internal Medicine (ABIM) Foundation was launched in 2012, with a goal of reducing overuse of tests and procedures and helping patients, in consultation with physicians, make smart and effective care choices. Since then, 30 professional societies have joined the effort, releasing lists of common practices that should be questioned by both healthcare professionals and patients.
This month, the Society of Hospital Medicine (SHM) released a proposed "Top 5" list of low-value care in pediatric hospital medicine, which was published in Journal of Hospital Medicine. Medscape spoke with Ricardo Quinonez, MD, Chair of the Pediatric Committee for SHM, about the recommendations and key take-home messages for clinicians. Dr. Quinonez is Associate Professor of Pediatrics at Baylor College of Medicine and Chief of the Section of Pediatric Hospital Medicine at Children's Hospital of San Antonio, Texas. He also chairs the Section on Hospital Medicine for the American Academy of Pediatrics and is a member of the advisory board at Medscape Pediatrics.
Medscape: Why is the topic of overuse important in medicine in general and pediatrics in particular?
Dr. Quinonez: Overuse, or the inappropriate or unnecessary use of medical tests and therapies, is a problem in medicine in general. It is admittedly more important in adults, where up to 30% of healthcare expenditures, at least in the United States, is due to waste. But it is definitely also a problem in pediatrics. Nobody has quantified it, but we have seen a significant lack of discussion of this issue. In contrast, in adult medicine there are whole books written about the subject. In pediatrics, it has barely even been discussed. In the many campaigns in adults on this topic, there is barely any pediatric discussion.
The Choosing Wisely campaign is one of the first to address this subject in pediatrics. Although our recommendations focus on inpatient care of children, overuse is also a significant issue in the outpatient setting. However, when it comes to healthcare expenditure, the hospital setting is probably one of the biggest offenders.
Medscape: So the Choosing Wisely campaign seems to be trying to do something about this problem. Are there any other efforts out there aimed at addressing the issue of overuse in children?
Dr. Quinonez: There are some -- some of them very good ones, but limited in scope -- such as Image Wisely™. This is a collaborative initiative of the American College of Radiology, the Radiological Society of North America, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine. They started with a campaign in adults, and they quickly expanded it to include radiation exposure to children, where it is probably even more important.
There are other efforts to address overuse in adult medicine. Archives of Internal Medicine launched an effort called Less Is More and published a number of articles and opinion pieces about the issue of overuse. An upcoming conference on this topic will, for the first time, have a fairly significant pediatric representation.
Editor's Note:
The Choosing Wisely® initiative of the American Board of Internal Medicine (ABIM) Foundation was launched in 2012, with a goal of reducing overuse of tests and procedures and helping patients, in consultation with physicians, make smart and effective care choices. Since then, 30 professional societies have joined the effort, releasing lists of common practices that should be questioned by both healthcare professionals and patients.
This month, the Society of Hospital Medicine (SHM) released a proposed "Top 5" list of low-value care in pediatric hospital medicine, which was published in Journal of Hospital Medicine. Medscape spoke with Ricardo Quinonez, MD, Chair of the Pediatric Committee for SHM, about the recommendations and key take-home messages for clinicians. Dr. Quinonez is Associate Professor of Pediatrics at Baylor College of Medicine and Chief of the Section of Pediatric Hospital Medicine at Children's Hospital of San Antonio, Texas. He also chairs the Section on Hospital Medicine for the American Academy of Pediatrics and is a member of the advisory board at Medscape Pediatrics.
Medscape: Why is the topic of overuse important in medicine in general and pediatrics in particular?
Dr. Quinonez: Overuse, or the inappropriate or unnecessary use of medical tests and therapies, is a problem in medicine in general. It is admittedly more important in adults, where up to 30% of healthcare expenditures, at least in the United States, is due to waste. But it is definitely also a problem in pediatrics. Nobody has quantified it, but we have seen a significant lack of discussion of this issue. In contrast, in adult medicine there are whole books written about the subject. In pediatrics, it has barely even been discussed. In the many campaigns in adults on this topic, there is barely any pediatric discussion.
The Choosing Wisely campaign is one of the first to address this subject in pediatrics. Although our recommendations focus on inpatient care of children, overuse is also a significant issue in the outpatient setting. However, when it comes to healthcare expenditure, the hospital setting is probably one of the biggest offenders.
Medscape: So the Choosing Wisely campaign seems to be trying to do something about this problem. Are there any other efforts out there aimed at addressing the issue of overuse in children?
Dr. Quinonez: There are some -- some of them very good ones, but limited in scope -- such as Image Wisely™. This is a collaborative initiative of the American College of Radiology, the Radiological Society of North America, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine. They started with a campaign in adults, and they quickly expanded it to include radiation exposure to children, where it is probably even more important.
There are other efforts to address overuse in adult medicine. Archives of Internal Medicine launched an effort called Less Is More and published a number of articles and opinion pieces about the issue of overuse. An upcoming conference on this topic will, for the first time, have a fairly significant pediatric representation.
