Choosing wisely in emergency medicine

A national survey of emergency medicine academic chairs and division chiefs

Brandon Maughan, Jill M. Baren, Judy A. Shea, Raina M. Merchant

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives The Choosing Wisely campaign was launched in 2011 to promote stewardship of medical resources by encouraging patients and physicians to speak with each other regarding the appropriateness of common tests and procedures. Medical societies including the American College of Emergency Physicians (ACEP) have developed lists of potentially low-value practices for their members to address with patients. No research has described the awareness or attitudes of emergency physicians (EPs) regarding the Choosing Wisely campaign. The study objective was to assess these beliefs among leaders of academic departments of emergency medicine (EM). Methods This was a Web-based survey of emergency department (ED) chairs and division chiefs at institutions with allopathic EM residency programs. The survey examined awareness of Choosing Wisely, anticipated effects of the program, and discussions of Choosing Wisely with patients and professional colleagues. Participants also identified factors they associated with the use of potentially low-value services in the ED. Questions and answer scales were refined using iterative pilot testing with EPs and health services researchers. Results Seventy-eight percent (105/134) of invited participants responded to the survey. Eighty percent of respondents were aware of Choosing Wisely. A majority of participants anticipate the program will decrease costs of care (72% of respondents) and use of ED diagnostic imaging (69%) but will have no effect on EP salaries (94%) or medical-legal risks (65%). Only 45% of chairs have ever addressed Choosing Wisely with patients, in contrast to 88 and 82% who have discussed it with faculty and residents, respectively. Consultant-requested tests were identified by 97% of residents as a potential contributor to low-value services in the ED. Conclusions A substantial majority of academic EM leaders in our study were aware of Choosing Wisely, but only slightly more than half could recall any ACEP recommendations for the program. Respondents familiar with Choosing Wisely anticipated generally positive effects, but chairs reported only infrequently discussing Choosing Wisely with patients. Future research should identify potentially low-value tests requested by consultants and objectively measure the utility and cost of these tests among ED patient populations.

Original languageEnglish (US)
Pages (from-to)1506-1510
Number of pages5
JournalAcademic Emergency Medicine
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Emergency Medicine
Hospital Emergency Service
Physicians
Emergencies
Consultants
Costs and Cost Analysis
Medical Societies
Salaries and Fringe Benefits
Emergency Medical Services
Diagnostic Imaging
Internship and Residency
Surveys and Questionnaires
Research Personnel
Research
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Choosing wisely in emergency medicine : A national survey of emergency medicine academic chairs and division chiefs. / Maughan, Brandon; Baren, Jill M.; Shea, Judy A.; Merchant, Raina M.

In: Academic Emergency Medicine, Vol. 22, No. 12, 01.12.2015, p. 1506-1510.

Research output: Contribution to journalArticle

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abstract = "Objectives The Choosing Wisely campaign was launched in 2011 to promote stewardship of medical resources by encouraging patients and physicians to speak with each other regarding the appropriateness of common tests and procedures. Medical societies including the American College of Emergency Physicians (ACEP) have developed lists of potentially low-value practices for their members to address with patients. No research has described the awareness or attitudes of emergency physicians (EPs) regarding the Choosing Wisely campaign. The study objective was to assess these beliefs among leaders of academic departments of emergency medicine (EM). Methods This was a Web-based survey of emergency department (ED) chairs and division chiefs at institutions with allopathic EM residency programs. The survey examined awareness of Choosing Wisely, anticipated effects of the program, and discussions of Choosing Wisely with patients and professional colleagues. Participants also identified factors they associated with the use of potentially low-value services in the ED. Questions and answer scales were refined using iterative pilot testing with EPs and health services researchers. Results Seventy-eight percent (105/134) of invited participants responded to the survey. Eighty percent of respondents were aware of Choosing Wisely. A majority of participants anticipate the program will decrease costs of care (72{\%} of respondents) and use of ED diagnostic imaging (69{\%}) but will have no effect on EP salaries (94{\%}) or medical-legal risks (65{\%}). Only 45{\%} of chairs have ever addressed Choosing Wisely with patients, in contrast to 88 and 82{\%} who have discussed it with faculty and residents, respectively. Consultant-requested tests were identified by 97{\%} of residents as a potential contributor to low-value services in the ED. Conclusions A substantial majority of academic EM leaders in our study were aware of Choosing Wisely, but only slightly more than half could recall any ACEP recommendations for the program. Respondents familiar with Choosing Wisely anticipated generally positive effects, but chairs reported only infrequently discussing Choosing Wisely with patients. Future research should identify potentially low-value tests requested by consultants and objectively measure the utility and cost of these tests among ED patient populations.",
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