High-Value Care | June 15, 2022 | FREE
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SHM selected new Choosing Wisely recommendations with patient input

The latest advice from the Society of Hospital Medicine (SHM) on avoiding low-value care includes recommendations against waking patients at night for routine care and against routinely prescribing venous thromboembolism prophylaxis to all inpatients.

The Society of Hospital Medicine (SHM) Choosing Wisely recommendations for adult inpatient care were recently updated with patient input.

The process by which the 1,265 recommendations submitted by clinicians and patients were whittled down to 22 recommendations for an SHM committee and patient advocates to vote upon was explained in an article published by the Journal of General Internal Medicine (JGIM) on June 6.

The vote resulted in six new recommendations, which were released on May 27.

  • Avoid using opioids for treatment of mild, acute pain. For moderate to severe acute pain, if opioids are used, it should be in conjunction with nonopioid methods with the lowest effective dose for the shortest required duration.
  • Don't maintain a peripheral capillary oxygen saturation of higher than 96% when using supplemental oxygen, unless for carbon monoxide poisoning, cluster headaches, sickle cell crisis, or pneumothorax.
  • Don't wake patients at night for routine care; redesign workflow to promote sleep at night.
  • Don't order creatine kinase or creatine kinase-myocardial band in suspected acute coronary syndrome or acute myocardial infarction.
  • Don't order daily chest radiographs in hospitalized patients unless there are specific clinical indications.
  • Do not routinely prescribe venous thromboembolism (VTE) prophylaxis to all hospitalized patients; use an evidence-based risk stratification system to determine whether a patient needs VTE prophylaxis. If they do warrant prophylaxis, use a bleeding risk assessment to determine if mechanical rather than pharmacologic prophylaxis is more appropriate.

The inclusion of equal number of clinicians and patients in the recommendation selection process “represents a shift in paradigm from paternalistic medicine and simply finding better ways to explain recommendations,” said the authors of the JGIM article. “Integrating patients' views from inception to completion is critical for determining if these CW [Choosing Wisely] recommendations are truly ‘low-value,’ as the patient is ultimately the end-consumer. … We hope that this will serve as a model for CW in the future.”