Reducing 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.
Resources:
- Acid Suppression Therapy Pocket Card for Indications
- Literature Review
- Sample smart phrases for use in EPIC (EMR)
Reducing 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.
Resources:
- Troponin Pocket Card
- Reducing Cardiac Enzymes Intervention at JHBMC. Publication in JGIM 2014.
- Choosing Wisely press
- ABIM press
- Johns Hopkins Medicine press
- ACC/AHA Guidelines 2014 (section 3.4)
Optimizing 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)
Resources:
- Telemetry Pocket Card
- Literature Review
- Teaching Scenarios Resource
- American Heart Association Guidelines
- Choosing Wisely recommendations (Society of Hospital Medicine)
Decreasing 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.
Resources:
- ICU Chest X-Ray Pocket Card
- Literature Review
- Teaching Scenarios Resource
- American College of Radiology Guidelines
- ICU Chest X-Rays Meta-analysis in Radiology
- ICU Chest X-Rays Meta-analysis in Critical Care
- Choosing Wisely recommendations (Critical Care Societies Collaborative)
Ordering 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
Resources:
- Ordering Wisely One Page Guidelines (literature review included)
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.
Resources:
