Feb. 18—Imaging procedures dominated a top-five list of emergency medicine procedures that a new study found to have the lowest value and that offer the greatest potential to reduce healthcare costs.

The five leading emergency medicine cost-control targets were identified through a study by Jeremiah D. Schuur, MD, of Brigham and Women’s Hospital in Boston and his colleagues. The study was published online in JAMA Internal Medicine on Monday.

The top-five list was derived through a pilot version of a process that hospital emergency departments (EDs) could use to identify “actionable targets of overuse,” the authors wrote. The list was determined by majority support of a technical expert panel for reducing the use of emergency tests and procedures weighed by a modified Delphi process.

The list recommends that emergency physicians avoid ordering: 

  • Computed tomography (CT) scans of the cervical spine for trauma patients who do not meet high-risk criteria
  • CT scans to diagnose pulmonary embolism without first determining a patient’s risk for pulmonary embolism
  • Magnetic resonance imaging of the lumbar spine for patients with lower back pain without high-risk features
  • CT scans of the head for patients with mild traumatic head injury who do not meet high-risk criteria
  • Anticoagulation studies for patients without hemorrhage or suspected clotting disorder 

The selected emergency “clinical actions” were described as “low value, within clinician control, and for which consensus existed among ED health care clinicians.”

“Some [emergency physicians (EPs)] may be hesitant to embrace stewardship of efforts, such as Choosing Wisely, for fear of losing autonomy and the medicolegal risk,” the authors wrote about the waste-avoidance recommendations issued by some medical societies in recent years. “However, if EPs who best understand the clinical evidence and unique needs of our patients do not define measures of overuse for our specialty, others will.”

Publication Date: Tuesday, February 18, 2014