The list
by Kaity Hemgesberg

Yesterday, JAMA published a list of  tests and treatments ordered in the Emergency Department which a group of 283 Emergency clinicians considered the most wasteful. Because accessing the list requires a log-in (which is a bit of a waste!) I have copied it here.

Below this is a similar list from the Choosing Wisely campaign where GPs were asked to vote on their most wasteful tests and treatments in 2012.

Consider doing them…and then don’t!

ED list of things most considered wasteful

1. CT cervical spine for patients after trauma (without high-risk features)
2. CT to diagnose pulmonary embolism without first determining a patient’s risk for pulmonary embolism
3. MRI lumbar spine for patients with lower back pain (without high-risk features)
4. CT head for patients with mild traumatic head injury (without high-risk features)
5. Blood clotting assessment for patients without bleeding or unless they are on anticoagulation therapy or have a clotting disorder
6. Blood cultures for patients (without sepsis) who have a skin infection
7. Hospital admission for patients with low-risk chest pain
8. Prescribing brand-name antibiotics instead of generics for patients with UTI, pneumonia or cellulitis
9. Giving antibiotics IV instead of orally (where tolerated)

GP (family physician) list of things most considered wasteful

1. Imaging for acute low back pain without red flags
2. Antibiotics for acute sinusitis (uncomplicated)
3. BMD screening for osteoporosis in younger, low-risk patients
4. Routine cardiac tests for asymptomatic, low-risk patients
5. Pap smears for women under 21 and those who have had a hysterectomy for non-cancerous conditions