Healthcare News & Insights

Tests and procedures that aren’t always necessary


Better prepare physicians at your hospital to be questioned by patients about certain tests they order. The reason is the ABIM Foundation has released a new list of 85 tests and procedures that patients should questions doctors about when ordered as part of their care.

If you remember back in April of 2012, nine medical specialty societies each selected five procedures that medical evidence showed had little or no value for certain conditions. The purpose wasn’t to try to eliminate these tests and treatments, but to get doctors and their patients to question their use in particular cases.

The list was meant to be used as a set of guidelines.

Now 17 more medical specialty societies have joined the ABIM Foundation’s Choosing Wisely campaign each selecting five tests or procedures which aren’t always necessary. That makes a grand total of 130 tests and procedures that are on the list and more than 350,000 physicians represented by the 26 medical societies.

The tests and procedures on the list aren’t just picked randomly, they are selected after months of scrutiny. The specialty groups use the most current evidence about management and treatment options within their specialty. The hope is that these recommendations will improve patient care and safety. But in the end, they should also save money.

Recommendation examples

Here are some recommendations made by the new contributing specialty societies:

Don’t perform routine annual Pap tests in women 30 to 65 years of age. The American College of Obstetricians and Gynecologists made this recommendation based on the fact that routine annual Pap tests offer no advantage over screenings performed at three-year intervals for the average-risk woman.

Don’t perform electroencephalography (EEGs) on patients with recurrent headaches. According to the American Academy of Neurology, EEGs have no advantage over clinical evaluation in diagnosing headaches and they don’t improve outcomes. What they do is increase costs, because recurrent headaches is the most common pain problem affecting up to 20% of the population.

Don’t place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for non-critically ill patients. The Society of Hospital Medicine — Adult Hospital Medicine, states that catheter associated urinary tract infections (CAUTIs) are the most frequently occurring healthcare acquired infection (HAI). Use of urinary catheters for incontinence or convenience without proper indication or specified optimal duration of use increases the likelihood of infection and is commonly associated with greater morbidity, mortality and healthcare costs.

Don’t order chest radiographs in children with uncomplicated asthma or bronchiolitis. According to the Society of Hospital Medicine — Pediatric Hospital Medicine, national guidelines articulate a reliance on physical examination and patient history for diagnosis of asthma and bronchiolitis in the pediatric population. Multiple studies have established limited clinical use of chest radiographs for patients with asthma or bronchiolitis. Omission of the use of chest radiography will reduce costs, but not compromise diagnostic accuracy and care.

Antibiotics shouldn’t be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis). Although overall antibiotic prescription rates for children have dropped off, they’re still extremely high, which is why the American Academy of Pediatrics made this recommendation. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher healthcare costs and the risks of adverse events.

For a complete list of the medical specialty societies, click here. To download a PDF of all the tests and procedures identified by the societies, click here.






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