Top-Five List to Improve Emergency Medicine

Five emergency procedures considered of low value by emergency health care providers

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Curbing the number of potentially needless medical treatments is a key part of improving health care. The emergency department is one place to achieve cost-savings and better care of patients.

A group of emergency physicians and other medical professionals has developed a list of five emergency procedures that, based on new research, they advise some patients with mild head trauma, back pain and other seemingly less severe problems to go without.

The overused procedures include some computed tomograpy (CT) and magnetic resonance imaging (MRI) scans that should be reserved for diagnosing more severe disorders, including those among older patients, according to these researchers.

"Ask about the need for emergency medical treatments."

These suggestions are based on a study led by Jeremiah D. Schuur, MD, MHS, an emergency medicine specialist at Brigham and Women’s Hospital in Boston.

For this study, Dr. Schuur and his team of researchers enlisted a total of 283 emergency physicians, physician assistants and nurse practitioners from six emergency medical departments run by Partners Healthcare in eastern Massachusetts.

A total of 283,174 clinicians completed the survey of what, based largely on scientific proof, they considered to be the least useful of commonly done emergency procedures. They factored in the costs of procedures and potential harm to patients. Of the respondents, 58 percent were doctors.

Based on the clinicians’ responses, the researchers developed an initial list of 64 procedures whose benefits were questionable. Then, through a series of additional surveys of study participants, the researchers narrowed those procedures down to this list of five procedures that should not be ordered:

  • Computed tomography (CT) scans of the cervical spine for injured patients unless they are aged 65 or older, cannot rotate their necks properly or have other higher risks.
  • CT scans should not be used to diagnose a pulmonary embolism (PE), a problem usually caused by a blood clot in the lung, without first determining the patient's risk for a PE.
  • Magnetic resonance imaging (MRI) of the lumbar spine for patients who have lower back pain but do not show high risks for spine problems.
  • CT scans of the head for patients with mild traumatic head injury unless they are aged 65 or older, have certain kinds of head fractures or memory loss, were struck or thrown from a vehicle or have other high risks.
  • Anti-coagulation studies for patients without known problems with excessive bleeding or blood clotting.

These researchers argued against certain routinely ordered procedures because they are driving up emergency medical costs, may not help patients and, in some cases, may harm them. From 2003 through 2011, the average cost of one visit to an emergency department rose 240 percent, from $560 to $1,354.

“Emergency medicine is under immense pressure to improve the value of health care services delivered. Emergency physicians and the organizations that represent them have an obligation to their patients and to society to address the cost of emergency care director,” the researchers wrote.

This latest list of five medical procedures to avoid, given their costs and relatively low value to patients and their doctors, follow the American Board of Internal Medicine's Choosing Wisely campaign. The campaign has resulted in several groups representing medical specialities to develop lists of procedures to steer away from.

This study was published online February 17 in JAMA Internal Medicine.

A research grant from the Emergency Medicine Residents’ Association funded this study.

None of the seven researchers reported any investments or financial involvements that would affect study design, analysis or outcomes.

Review Date: 
February 17, 2014
Last Updated:
February 18, 2014