Skip to main content Accessibility help
×
Home
Hostname: page-component-846f6c7c4f-jk8t6 Total loading time: 0.385 Render date: 2022-07-07T08:55:34.124Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship

Published online by Cambridge University Press:  28 March 2016

Daniel J. Morgan*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology, Veterans Affairs Maryland Health Care System, Baltimore, Maryland Center for Disease Dynamics, Economics and Policy, Washington, DC
Lindsay D. Croft
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Valerie Deloney
Affiliation:
The Society for Healthcare Epidemiology of America, Arlington, Virginia
Kyle J. Popovich
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Chris Crnich
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Neil O. Fishman
Affiliation:
Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Kristina Bryant
Affiliation:
University of Louisville, Louisville, Kentucky
Sara E. Cosgrove
Affiliation:
Johns Hopkins University, Baltimore, Maryland
Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Address correspondence to Daniel J. Morgan, MD, MS, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore St, MSTF 334, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu).

Abstract

OBJECTIVE

To identify Choosing Wisely items for the American Board of Internal Medicine Foundation.

METHODS

The Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA–Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board.

RESULTS

Ninety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don’t perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don’t continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included.

CONCLUSIONS

These 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse.

Infect Control Hosp Epidemiol 2016;37:755–760

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Morgan, DJ, Brownlee, S, Leppin, AL, et al. Setting a research agenda for medical overuse. BMJ 2015;351:h4534.CrossRefGoogle Scholar
2. Buist, D, Collado, M. Promoting the appropriate use of health care services: research and policy priorities. http://www.academyhealth.org/files/HealthCareResourceUse/ResourceUseIssueBrief2014.pdf. Published 2014. Accessed October 13, 2015.Google Scholar
3. Burns, M, Dyer, M, Bailit, M. Bailit Health Purchasing. Reducing overuse and misuse: state strategies to improve quality and cost of health care. Robert Wood Johnson Foundation website. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409990. Published 2014. Accessed October 13, 2015.Google Scholar
4. Agency for Healthcare Research and Quality (AHRQ) Appropriateness Small Conference. Developing a framework and research agenda for overuse and appropriateness measures. http://www.ncqa.org/LinkClick.aspx?fileticket=N7sXd0kv-u0%3D&tabid=1510&mid=1501. Published June 9, 2009.Google Scholar
5. Choosing Wisely: promoting conversations between providers and patients. American Board of Internal Medicine Foundation website. http://www.choosingwisely.org/. Published 2015. Accessed October 13, 2015.Google Scholar
6. Choosing Wisely: newsletter archive. American Board of Internal Medicine Foundation website. http://www.choosingwisely.org/resources/updates-from-the-field/. Published 2016. Accessed January 21, 2016.Google Scholar
7. Larochelle, MR, Knight, AM, Pantle, H, Riedel, S, Trost, JC. Reducing excess cardiac biomarker testing at an academic medical center. J Gen Intern Med 2014;29:14681474.CrossRefGoogle Scholar
8. Boulkedid, R, Abdoul, H, Loustau, M, Sibony, O, Alberti, C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLOS ONE 2011;6:e20476.CrossRefGoogle ScholarPubMed
9. Powell, C. The Delphi technique: myths and realities. J Adv Nurs 2003;41:376382.CrossRefGoogle ScholarPubMed
10. Okoli, C, Pawlowski, SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag 2004;42:1529.CrossRefGoogle Scholar
11. Choosing Wisely recommendations. American Board of Internal Medicine Foundation website. http://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf. Published 2015. Accessed January 21, 2016.Google Scholar
12. Compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Strategies to prevent HAIs. Society for Healthcare Epidemiology of America website. http://www.shea-online.org/PriorityTopics/CompendiumofStrategiestoPreventHAIs.aspx. Published 2014. Accessed October 25, 2015.Google Scholar
13. Ho, T, Dukhovny, D, Zupancic, JA, Goldmann, DA, Horbar, JD, Pursley, DM. Choosing Wisely in newborn medicine: five opportunities to increase value. Pediatrics 2015;136:e482e489.CrossRefGoogle ScholarPubMed
14. Langer-Gould, AM, Anderson, WE, Armstrong, MJ, et al. The American Academy of Neurology’s top five Choosing Wisely recommendations. Neurology 2013;81:10041011.CrossRefGoogle ScholarPubMed
15. Halpern, SD, Becker, D, Curtis, JR, et al. An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® top 5 list in critical care medicine. Am J Respir Crit Care Med 2014;190:818826.CrossRefGoogle ScholarPubMed
16. Wiener, RS, Ouellette, DR, Diamond, E, et al. An official American Thoracic Society/American College of Chest Physicians policy statement: the Choosing Wisely top five list in adult pulmonary medicine. Chest 2014;145:13831391.CrossRefGoogle ScholarPubMed
17. Loder, E, Weizenbaum, E, Frishberg, B, Silberstein, S. Choosing Wisely in headache medicine: the American Headache Society’s list of five things physicians and patients should question. Headache 2013;53:16511659.CrossRefGoogle ScholarPubMed
18. Morgan, DJ, Deloney, VM, Bartlett, A, et al. The expanding role of the hospital epidemiologist in 2014: a survey of the Society for Hospital Epidemiology of America (SHEA) Research Network. Infect Control Hosp Epidemiol 2015;36:605608.CrossRefGoogle Scholar
19. Morgan, DJ, Meddings, J, Saint, S, et al. Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? Clin Infect Dis 2012;55:923929.CrossRefGoogle ScholarPubMed
20. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed October 13, 2015.Google Scholar
21. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Published 2015. Accessed October 13, 2015.Google Scholar
22. Elligsen, M, Walker, SA, Pinto, R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354361.CrossRefGoogle ScholarPubMed
23. Klompas, M, Anderson, D, Trick, W, et al. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015;191:292301.CrossRefGoogle ScholarPubMed
24. Lo, E, Nicolle, LE, Coffin, SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:S32S47.CrossRefGoogle Scholar
25. Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753771.CrossRefGoogle ScholarPubMed
26. Peterson, LR, Robicsek, A. Does my patient have Clostridium difficile infection? Ann Intern Med 2009;151:176179.CrossRefGoogle ScholarPubMed
27. Dubberke, ER, Carling, P, Carrico, R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:S48S65.CrossRefGoogle ScholarPubMed
28. Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365369.CrossRefGoogle Scholar
29. Drekonja, DM, Amundson, WH, DeCarolis, DD, Kuskowski, MA, Lederle, FA, Johnson, JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med 2011;124:1081.CrossRefGoogle ScholarPubMed
30. Shaughnessy, MK, Amundson, WH, Kuskowski, MA, DeCarolis, DD, Johnson, JR, Drekonja, DM. Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection. Infect Control Hosp Epidemiol 2013;34:109116.CrossRefGoogle ScholarPubMed
31. Anderson, DJ, Podgorny, K, Berríos-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:S66S88.CrossRefGoogle ScholarPubMed
32. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195283.CrossRefGoogle ScholarPubMed
33. Antimicrobial stewardship. Society for Healthcare Epidemiology of America. http://www.shea-online.org/PriorityTopics/AntimicrobialStewardship.aspx. Accessed October 25, 2015.Google Scholar
34. Sendén, MG, Løvseth, LT, Schenck-Gustafsson, K, Fridner, A. What makes physicians go to work while sick: a comparative study of sickness presenteeism in four European countries (HOUPE). Swiss Med Wkly 2013;143:w13840.Google Scholar
35. Aronsson, G, Gustafsson, K, Dallner, M. Sick but yet at work. An empirical study of sickness presenteeism. J Epidemiol Community Health 2000;54:502509.CrossRefGoogle Scholar
36. Bracewell, LM, Campbell, DI, Faure, PR, et al. Sickness presenteeism in a New Zealand hospital. N Z Med J 2010;123:3142.Google Scholar
37. Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65164.CrossRefGoogle ScholarPubMed
26
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *