A Broader View of Quality: Choosing Wisely Recommendations From Other Specialties With High Relevance to Emergency Care

Study objective: The American College of Emergency Physicians (ACEP) joined the Choosing Wisely campaign in 2013 and has contributed 10 recommendations to reduce low-value care. Recommendations from other specialties may also identify opportunities to improve quality and patient safety in emergency care. The Choosing Wisely work group of the ACEP Quality and Patient Safety Committee seeks to identify and characterize the Choosing Wisely recommendations from other professional societies with the highest relevance to emergency care. Methods: In June 2016, all Choosing Wisely recommendations from other specialties were obtained from the American Board of Internal Medicine Foundation. Using a modified Delphi method, the 10 group members rated recommendations for relevance on a validated 7-point scale. Recommendations identified as highly relevant (median score=7) were rated on 3 additional characteristics: cost savings (1=large, 5=none), risk-benefit profile (1=benefit >risk, 5=risk >benefit), and actionability by emergency physicians (1=complete, 5=none). Results are presented as overall means (eg, mean of subcategory means) and subcategory means with SDs. Results: Initial review of 412 recommendations identified 49 items as highly relevant to emergency care. Eleven were redundant with ACEP recommendations, leaving 38 items from 25 professional societies. Overall means for items ranged from 1.57 to 3.1. Recommendations’ scores averaged 3.2 (SD 0.6) for cost savings, 1.9 (SD 0.4) for risk-benefit, and 1.6 (SD 0.5) for actionability. The most common conditions in these recommendations were infectious diseases (14 items; 37%), head injury (4 items; 11%), and primary headache disorders (4 items; 11%). The most frequently addressed interventions were imaging studies (11 items; 29%) and antibiotics (9 items; 24%). Conclusion: Thirty-eight Choosing Wisely recommendations from other specialties are highly relevant to emergency care. Imaging studies and antibiotic use are heavily represented among them.