Dr. Ricardo Quinonez of Children's Hospital of San Antonio and Baylor College of Medicine published a comprehensive study of the most commonly prescribed unnecessary procedures, tests, and therapies for adults and children in the Aug. 19, 2013, issue of the Journal of Hospital Medicine.
The research included a review of the medical literature and responses from teaching hospitals and for profit hospitals across the United States to accommodate the variety of care environments and health issues in various parts of the United States.
The effort is a part of the Choosing Wisely® campaign that seeks to reduce and eliminate the unneeded tests and therapies that produce as much as 20 percent of present medical costs. The program is supported and recommended by the American Board of Internal Medicine Foundation and the Society of Hospital Medicine.
Only a few hospitals have adopted the guidelines as rules and few pediatricians actively made these guidelines a part of their standard practice.
If a person wishes to reduce their health care costs they must actively insist that their doctors and pediatricians follow the cost saving guidelines.
The guidelines for pediatric care are:
“Don't order chest radiographs in children with asthma or bronchiolitis. This has the potential to decrease costs, reduce radiation exposure, and minimize the overuse of antibiotics due to false positive results.
Don't use bronchodilators in children with bronchiolitis because the agents have minimal or no treatment effects.
Don't use systemic corticosteroids in children under two years of age with a lower respiratory tract infection because the treatment is potentially harmful and provides little or no benefit.
Don't treat gastroesophageal reflux in infants routinely with acid suppression therapy, such as proton pump inhibitors. Studies show that such treatment is no more effective than placebo in infants, and it may cause side effects.
Don't use continuous pulse oximetry - a method for measuring oxygen saturation in the blood - routinely in children with acute respiratory illness unless they are on supplemental oxygen. Continuous monitoring of oxygen saturations in hospitalized infants with bronchiolitis may lead to over diagnosis of hypoxemia, increased hospital duration, and the use of oxygen that is of no apparent benefit to the child.”
The guidelines for adult care are:
“Do not place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for non-critically ill patients.
Do not prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for gastrointestinal complications.
Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms or active coronary disease, heart failure, or stroke.
Do not order continuous telemetry monitoring outside of the intensive care unit without using a protocol that governs continuation.
Do not perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability.”