Background: Choosing Wisely recommends against testing for amylase in the diagnosis and management of acute pancreatitis; however, national CMS data shows over $19 million in charges for amylase laboratory testing per year. Our hospital spent over $341,000 on roughly 38,000 amylase orders in the past year. Purpose: We developed a quality improvement project to reduce [...]

Background: Formal curricula for teaching medical students high value care are lacking, and there is little evidence identifying strategies that can effectively impact students’ knowledge and skills. Research is needed to develop models for student-led HVC implementation in healthcare settings. Purpose: To create a student-led longitudinal curricular experience that leads to improvements in utilization outcomes. [...]

Background:  Transthoracic echocardiography (TTE) is one of the most popular tests in healthcare. Studies of Medicare beneficiaries for example have shown that each year approximately 20% undergo at least one TTE. Repeat TTE defined as TTE done within one year of a prior TTE represent 24-42% of all studies. In the present study we derive [...]

Background: Decades-old clinical data and practice guidelines support the use of lipase over amylase in the workup and management of acute pancreatitis. Yet, laboratory testing for amylase continues to cost the Center for Medicare and Medicaid Services more than $19 million in largely avoidable charges each year. Previously hypothesized drivers of overutilization of amylase testing [...]

Background: As part of the ABIM Foundation’s Choosing Wisely campaign the Society of Hospital Medicine recommended providers avoid performing repetitive CBC and chemistry testing in the face of clinical and lab stability. In 2014 as part of an EMR upgrade our institution removed the “daily labs” order. A 1-year post change audit showed no change [...]

Background: The Choosing Wisely campaign aims to engage clinicians and public in addressing overuse in healthcare. Through adoption in 20 countries and 75 organizations, clinician engagement is largely successful. However, patient and public engagement remains a challenge, and there is concern that the impact of Choosing Wisely will be dampened if this is not achieved. [...]

Background: Constipation accounts for approximately 20,000 hospitalizations in the United States per year and contributes to increased length of stay for patients hospitalized with other diagnoses. Docusate is routinely prescribed for inpatient constipation although extensive studies have shown minimal effectiveness. It contributes to increased pill burden and polypharmacy for patients, and adds to unnecessary use [...]

Background: The United States has the highest expenditure per capita and fastest growth when it comes to health care. Imaging is one of the fastest growing services in medicine reaching approximately $100 billion annually. There have been criticisms that imaging studies are often over utilized and inappropriate which results in unnecessary costs and waste. Our [...]

Background: Hypertensive crisis is classified as either hypertensive emergency or hypertensive urgency, distinguished by presence or absence of end-organ damage, respectively. Guidelines recommend treating hypertensive emergency with intravenous (IV) antihypertensive medications for immediate blood pressure reduction. On the other hand, management of hypertensive urgency involves gradual reduction of blood pressure over hours to days using [...]

Background: Medical overuse, defined as the provision of services for which harms outweigh benefits, is increasingly recognized as a driver of high cost and poor clinical outcomes in the U.S. health care system. Despite increasing attention to overuse, methods for reducing it are unclear. In contrast, methods of identification, analysis, and prevention of medical errors [...]