title: Choosing wisely in pediatric hospital medicine: five opportunities for improved healthcare value.
abstract: BACKGROUND
  Despite estimates that waste constitutes up to 20% of healthcare expenditures in the United States, overuse of tests and therapies is significantly under-recognized in medicine, particularly in pediatrics. The American Board of Internal Medicine Foundation developed the Choosing Wisely campaign, which challenged medical societies to develop a list of 5 things physicians and patients should question. The Society of Hospital Medicine (SHM) joined this effort in the spring of 2012. This report provides the pediatric work group's results.
  
  
  METHODS
  A work group of experienced and geographically dispersed pediatric hospitalists was convened by the Quality and Safety Committee of the SHM. This group developed an initial list of 20 recommendations, which was pared down through a modified Delphi process to the final 5 listed below.
  
  
  RESULTS
  The top 5 recommendations proposed for pediatric hospital medicine are: (1) Do not order chest radiographs in children with asthma or bronchiolitis. (2) Do not use systemic corticosteroids in children under 2 years of age with a lower respiratory tract infection. (3) Do not use bronchodilators in children with bronchiolitis. (4) Do not treat gastroesophageal reflux in infants routinely with acid suppression therapy. (5) Do not use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen.
  
  
  CONCLUSIONS
  We recommend that pediatric hospitalists use this list to prioritize quality improvement efforts and include issues of waste and overuse in their efforts to improve patient care.
authors: Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, Texas.
authors: Ricardo A
authors: RA
authors: Quinonez
authors: Matthew D
authors: MD
authors: Garber
authors: Alan R
authors: AR
authors: Schroeder
authors: Brian K
authors: BK
authors: Alverson
authors: Wendy
authors: W
authors: Nickel
authors: Jenna
authors: J
authors: Goldstein
authors: Jeffrey S
authors: JS
authors: Bennett
authors: Bryan R
authors: BR
authors: Fine
authors: Timothy H
authors: TH
authors: Hartzog
authors: Heather S
authors: HS
authors: McLean
authors: Vineeta
authors: V
authors: Mittal
authors: Rita M
authors: RM
authors: Pappas
authors: Jack M
authors: JM
authors: Percelay
authors: Shannon C
authors: SC
authors: Phillips
authors: Mark
authors: M
authors: Shen
authors: Shawn L
authors: SL
authors: Ralston
mesh_terms: D002755:Choice Behavior; D064416:Hospital Medicine / Q000379:methods / Q000592:standards*; D020445:Hospitalists / Q000592:standards*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012955:Societies, Medical / Q000592:standards; D014481:United States