377 - Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value and Outcomes

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 377
Publication Number: 377.212

Paul C. Mullan, Children's Hospital of The King's Daughters, Division of Emergency Medicine, Norfolk, VA, United States; Kelly Levasseur, Children's Hospital of Michigan, Detroit, MI, United States; LALIT BAJAJ, University of Colorado, Denver, CO, United States; Michele Nypaver, University of Michigan-Michigan Medicine, Northville, MI, United States; James Chamberlain, Children's National Health System, Washington, DC, United States; Olivia Ostrow, The Hospital for Sick Children, Toronto, ON, Canada; Jennifer Thull-Freedman, University of Calgary, Calgary, AB, Canada; Shabnam Jain, Emory University School of Medicine, Atlanta, GA, United States

Presenting Author(s)

Paul C. Mullan, MD, MPH (he/him/his)

Director of Quality Improvement and Research, Attending Physician, Emergency Medicine
Children's Hospital of The King's Daughters, Division of Emergency Medicine
EVMS
Norfolk, Virginia, United States

Background: Unnecessary diagnostic testing in children cared for in emergency departments (EDs) occurs commonly, contributes to health care waste, and can be associated with patient harm. Choosing Wisely (CW) is a program designed to emphasize best-practice recommendations and address barriers to the growing global problem of unnecessary testing.

Objective: A task force of U.S. and Canadian pediatric emergency medicine (PEM) physicians was formed to create a CW recommendation list for children receiving care in EDs.

Design/Methods: The task force first collected suggested recommendations from an interprofessional group of ED providers (physicians, nurses, & advanced practice providers) from six academic pediatric EDs. After duplicative items were removed, the task force members independently scored these items on an anchored rating scale based on each item’s frequency of overuse in a typical ED shift, the strength of the evidence base, and potential harm with overuse. The 25 highest-rated items were sent in an electronic survey to 89 PEM quality improvement experts in the American Academy of Pediatrics (AAP) to select their top 10 recommendations. Task force members then removed any Items that were similar to items already published on non-PEM sub-specialty CW lists. The five most frequently chosen items on the survey became the final PEM CW list. These five items were then circulated to >100 sub-specialty groups (within the AAP, CW Canada, and CW USA organizations) for their review, feedback, and approval prior to publishing the list.

Results: A total of 205 suggested items were initially collected from the six pediatric EDs. Seventy-two non-duplicative items were independently scored by the task force to create the top 25 item electronic survey. The survey had a 63% response rate. Task force members removed three items based on their similarity to existing CW items on non-PEM CW lists. The final five items were published by CW USA and CW Canada on December 1, 2022 (Table 1).

Conclusion(s): A multinational PEM task force used a rigorous scientific process to develop the first CW list for pediatric patients in the ED setting. Future activities will include dissemination of this CW list and the design and implementation of effective interventions aimed at improving clinical practices specific to these CW items.