The Skeptic´s Guide to EM - By admin - February 22, 2020
"EM RIGHT CARE TOP 10 LIST:
Listen to the SGEM podcast to hear Dr. Dorsett and Cooper expand on each of these items.
- Avoid further testing beyond history, physical exam, clinical gestalt and ECG in patients who are at minimal risk of an acute coronary syndrome (ACS).
- Avoid further testing beyond history, physical exam and clinical gestalt in patients who are at minimal risk of pulmonary embolus (PE).
- Be judicious with the use of imaging, especially advanced imaging, in trauma patients.
- Avoid routine laboratory testing.
- Consider non-medical reasons for a patient’s presentation to the ED.
- Tailor the intensity of care to the goals of the patient.
- Employ shared decision-making (SDM) where appropriate.
- When prescribing an intervention, make an effort to ensure that the patient is capable of accomplishing what is recommended.
- Tailor discharge instructions and follow-up recommendations to the individual patient.
- Be an advocate.
Conclusion: “The RCA is working to change the conversation about American healthcare, advocating for access for all individuals to high-quality care without financial hardship, eliminating overuse and underuse, and championing the partnership between the patient and clinician. The EM Council’s top 10 list seeks to serve as a starting point to focus ED clinicians in achieving the goals of the RCA. While other lists exist, and we agree with many Choosing Wisely areas of focus, we seek to move the needle even further. In what is ultimately an impossible attempt never to miss a single case with a life-threatening diagnosis, we paradoxically cause a great deal of harm to the overall population through over-testing and contribute to the untenable rising cost of healthcare...”