Hospital Tests, Procedures You Don't Need

August 19, 2013

News Review From Harvard Medical School -- Hospital Tests, Procedures You Don't Need

Avoiding some tests and practices often done in hospitals can save money, without affecting quality of care, an expert group says. The Journal of Hospital Medicine published the recommendations online August 19. The advice comes from the Choosing Wisely campaign, an alliance of doctors. The group recommends ways to reduce waste in medicine. It has focused on releasing lists of tests, procedures and treatments that often are not needed. The list just published comes from the Society of Hospital Medicine and the American Board of Internal Medicine Foundation. It lists five items that often are not needed for children in the hospital. For example, the group says not to order chest X-rays for most children with asthma or bronchiolitis. Drugs to suppress acid in babies with reflux also don't work, the group says. Five more items are listed for adult patients. For example, the group says to avoid using a catheter to drain urine just for convenience or keeping track of output. This applies to people who are not critically ill. Also, don't keep repeating certain blood tests if results have been stable, the group says.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

An estimated $900 billion of health care spending is wasted each year. A big chunk of this comes from doctors ordering tests that yield little useful information or doing procedures that don't make their patients better.

This happens for several reasons. Some doctors just don't know which procedures or tests are useful and which ones aren't. Some order useless tests because their patients expect or ask for them. Others do it to protect themselves from possible lawsuits.

A new campaign called Choosing Wisely is now taking aim at wasteful health-care spending. The effort is led by the American Board of Internal Medicine Foundation and nine highly regarded medical organizations. Last year, the group published its first list of tests, procedures and treatments that are most often not needed. At the least, they should lead to a discussion between doctor and patient about the benefits and risks.

Each of the 9 medical organizations chose its "top 5" suggestions (a total of 45 items). This first list was geared toward better cost-effective practices in office and emergency department visits. You can view the full list at www.choosingwisely.org.

Now 17 more medical societies have joined the Choosing Wisely campaign. Among them is the Society of Hospital Medicine. Today the society published its list of suggestions to reduce wasteful spending in the hospital for children and adults. Examples include:

• More appropriate use of certain drugs
• Not ordering daily blood tests just because a patient is in the hospital
• Giving a blood transfusion based on each person's needs rather than doing it automatically when a red blood cell count gets below a certain number 

What Changes Can I Make Now? 

The list from the Society of Hospital Medicine is aimed at doctors taking care of patients in the hospital. But if you are in the hospital, you can participate and help reduce costs. And you should.

Ask questions. You might not be inclined or feel like you have the time to ask your doctor. But your primary nurse is with you all day. He or she is an excellent resource to answer your questions. Or the nurse can send a message to the doctor about your concerns.

Be sure to ask about the benefits and risks of any medicine, test or procedure. This potentially can reduce costs. It also helps to make your hospital stay safer.

Here are some standard questions to ask that also improve safety:

• Am I receiving blood clot prevention? People in the hospital are at increased risk of blood clots forming in the legs. Medicines, mechanical devices on the legs or both can help to prevent clots.
• Can any of the tubes be removed today? For example, hospital patients often have intravenous lines for medicines and catheters to drain urine. Keeping the number of tubes going into the body to a minimum helps to decrease infection risk.
• How soon and how often can I get out of bed and start walking? This question sends a message to everyone about your eagerness to get moving. Starting to move sooner means faster recovery and a shorter hospital stay.
• What should I do about hand cleansing? Also feel free to remind all visitors to wash their hands before and after touching you.
• What should I do now to be prepared for my discharge? It's never too early to start planning for your transition home.

What Can I Expect Looking to the Future? 

Avoiding tests and procedures that aren't effective or useful saves time and money. It also helps protect you from harm. For the Choosing Wisely campaign to be a success, all of us -- doctors and patients alike -- must stop believing that if some medical care is good, more is better.