Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Clinical Practice Guidelines

Background:

• Unnecessary diagnostic tests and treatments in pediatric emergency departments (EDs) contribute to increased costs and potential patient harm.
• Low-value care in pediatric emergency settings necessitates targeted interventions to improve patient outcomes and resource utilization.

Purpose of the Study:

• To develop the first Choosing Wisely recommendations specifically for pediatric emergency medicine (PEM).
• To identify and prioritize low-value diagnostic tests and treatments in pediatric EDs.

Main Methods:

• A systematic, iterative process involving a taskforce of PEM physicians and interprofessional ED clinicians.
• Collection and scoring of suggested items, followed by electronic surveys to the American Academy of Pediatrics PEM Committee on Quality Transformation (AAP COQT).
• Review and feedback from over 100 stakeholder and specialty groups across the US and Canada.

Main Results:

• The taskforce generated the first Choosing Wisely recommendations for pediatric EDs.
• Five key recommendations were finalized, focusing on reducing diagnostic testing for respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral infections.
• Recommendations were published simultaneously by Choosing Wisely United States and Choosing Wisely Canada.

Conclusions:

• A multinational PEM taskforce successfully developed evidence-based recommendations to decrease low-value care in pediatric EDs.
• Future efforts will focus on disseminating these recommendations and implementing interventions to enhance care quality and value.
• These guidelines represent a significant step towards optimizing care for pediatric patients in emergency settings.