A top-five of emergency medicine procedures that are of low value and could help control costs if providers do not order them was developed as part of a published study. 

The cost of medical care in the U.S. is growing at an unsustainable rate and the tests, treatments and hospitalizations that came form ED care are expensive, researchers noted in background information for the study, which was published Feb. 17on the website of JAMA Internal Medicine.

Jeremiah D. Schuur, MD, MHS, of Brigham and Women's Hospital in Boston, and colleagues assembled an expert panel to develop a top-five list of tests, treatments and other triage decisions that are of little value and are actionable by emergency medicine clinicians. 

The top-five recommends that emergency physicians:

  • Do not order computer tomography of the cervical spine after trauma for patients who do not meet high-risk criteria
  • Do not order CT to diagnose pulmonary embolism without first determining a patient's risk 
  • Do not Order magnetic resonance mating of the lumbar spine for the patients with lower back pain without high-risk features
  • Do not order CT of the head for patients with mild traumatic head injury who do not meet high-risk criteria
  • Do not order anticoagulation studies for patients without hemorrhage or suspected clotting disorder 

"Emergency is under immense pressure to improve the value of healthcare services delivered," the authors wrote. "Our project piloted the method that EDs can use to identify actionable targets of overuse; we identified clinical actions that were of low value, within clinician control and for which consensus existed among ED healthcare clinicians. Developing and addressing a top-five list is a first step to addressing the critical issue of the value of emergency care."


Study abstract: http://archinate.jamanetwork.com/article.aspx?articleid=1830019