Toolbox

ppi-picturesReducing Inappropriate Acid Suppression Therapy (proton-pump inhibitors, H2-blockers)

A pilot project where rounding pharmacists are given tools to help review patients’ medication lists and evaluate for appropriateness of acid suppression therapy (AST). Understanding that a large number of patients are on AST with no active indications, the goal is to reduce unnecessary long-term AST.

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troponinReducing Cardiac Enzyme Testing 

An intervention to improve evidence-based ordering of cardiac biomarkers to diagnose acute coronary syndrome. No more than three troponins for ACS. Only check total CK or CK-MB if troponin testing unavailable.

This project led to 66% reduction in ordering and $1.25 million decrease in charges at John Hopkins Bayview Medical Center.

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teleOptimizing Telemetry Utilization (Non-ICU)

An ongoing project to order telemetry per American Heart Association guidelines. Order for the appropriate indication and duration.

Why discontinue telemetry?

  • Low incidence of clinically significant arrhythmias for non-guideline indications
  • High burden of alarm fatigue
  • Resource intensive for nursing
  • Delaying hospital throughout
  • Patient risks (delirium and falls)

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cxrDecreasing Chest X-Rays in the ICU

An ongoing project to decrease routine morning chest x-rays in the intensive care unit.

Order chest x-rays based on symptoms to answer a clinical question.

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Ordering Wisely - One PagerOrdering Wisely

A project from University of Chicago, combining three high-value care guidelines into one initiative:

  • Appropriate Folate Testing
  • Appropriate Thyroid Function Testing
  • ANA First, a Judicious approach to Rheumatic work-up

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One Minute Guide to High Value Care

One Minute Guides to High Value Care, written by contributors from Johns Hopkins Hospital, and archived on the Medicine Matters blog.

Topics: Folate, Hepatitis C Inpatient testing, Nebulizer vs. MDI, Appropriate Urine Cultures, Telemetry and more.

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