Clinician-Led Stewardship To Curb Medical Excess

In a recent New England Journal of Medicine (NEJM) perspective, Durand and colleagues propose “medical-imaging stewardship.” They believe that imaging can be more appropriately used through “provider-led imaging stewardship,” based on the model of antimicrobial stewardship. Antimicrobial stewardship is a hospital program composed of an expert pharmacist and infectious disease physician. Its goal is to improve appropriateness of antimicrobial use through restriction of antibiotics, post-prescription review, and education. Clinician-led stewardship could limit overuse and improve care beyond antimicrobial use or imaging and should be considered for all areas of medicine. The comparison of imaging to antimicrobials is appropriate. Both imaging and antimicrobials are heavily overused; up to 50 percent of both are unnecessary. Likewise, both have objective harms to patients, with imaging leading to false-positive results such as incidentalomas, contrast, and radiation exposure and antimicrobials increasing risk for Clostridium difficile infection, drug side effects, and promotion of resistance. Both imaging and antimicrobials are often the response to uncertainty in clinical decisions: just to be safe let’s get a CT scan; just to be safe, take a week of ciprofloxacin. Imaging Stewardship Durand and colleagues imagine an Imaging Steward would (1) implement Choosing Wisely items related to imaging; (2) allocate resources towards information technology such as clinical-deci...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Health Professionals Hospitals Innovations in Care Delivery Medicare Quality antimicrobials Choosing Wisely Patient Safety patient uses of evidence Physicians Source Type: blogs