Education, Teaching, and Quality Improvement |

Less Is More "Choose Wisely" FREE TO VIEW

Arunima Rajbhandary, MBBS; Urooj Fatima, MBBS; Paras Dedhia, MD; Tasneem Kapadia, MD; Sheela Prabhu, MD
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Guthrie/Robert Packer Hospital, Sayre, PA

Chest. 2014;146(4_MeetingAbstracts):540A. doi:10.1378/chest.1993745
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SESSION TITLE: Quality & Clinical Improvement Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Know attitude among physicians about most appropriate choice of management in common clinical scenarios and changes after expert guidelines.

METHODS: Anonymous survey of 14 MCQs based on routine scenarios were sent to IM, FM residents, hospitalists and PCPs online in 3 stages: Pre intervention survey Educational intervention (concise guideline based on choosing wisely campaign/education in annual Guthrie symposium about cost effective care) Post intervention survey: (measure any change after educational intervention) It was approved by Institutional Review Board.

RESULTS: 50 out of 150 responded. 30% attending physicians/70% residents. 30% were unaware about choosing wisely program. When asked about management of acute sinusitis <6 days, 71% chose antibiotic in pre-intervetion survey and 30% in posteducation survey. 2-3% in both wanted CT scan of sinuses. For back pain for <3weeks, 83% wanted conservative management in first survey and 95% post-education survey. 16% wanted imaging (x-ray/MRI/CTscan) pre-intervention and 4% post-education. For syncope, pre-intervention, 66% opted no imaging and 30% carotid-duplex. Post-intervention, 86% no imaging and 11% carotid-duplex. For preoperative investigation on healthy patient for low risk non cardiac surgery, pre-intervention, 66% EKG, 29% no testing and 3.2% imaging (TTE or stress test). Post-intervention, 48% EKG and 51% no testing. Admission of simple pneumonia, pre-intervention 37% chose either GI prophylaxis, telemetry or both. Post-intervention, 27%. For blood transfusion for asymptomatic anemia, Pre-intervention, 37% wanted blood transfusion, 62% no blood transfusion. Post-intervention, 83% no blood transfusion. For recurrent abdominal pain due to functional abdominal pain, pre-intervention 71% chose abdominal imaging or colonoscopy compared to 17% post-intervention. About 70% found educational guideline helpful. They defered from guidelines due to fear of legal implication 35% , missing something 35% and habit or training 25%.

CONCLUSIONS: A wide range of disparity in choosing the most appropriate management among physicians was noticed. Also there was a as variation from expert guidelines. Significant improvement in compliance with guideline was noticed after concise educational intervention.

CLINICAL IMPLICATIONS: Therefore, similar widespread educational interventions among physicians as well as physicians in training will be helpful in making the high value cost effective choice.

DISCLOSURE: The following authors have nothing to disclose: Arunima Rajbhandary, Urooj Fatima, Paras Dedhia, Tasneem Kapadia, Sheela Prabhu

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