Practice Management Book

http://www.fpnotebook.com/

Best Practices by Specialty

Aka: Best Practices by Specialty, Choosing Wisely Campaign
  1. Precautions: Emergency Medicine
    1. Minor Head Trauma imaging
      1. Avoid Head CT in minor Head Trauma when validated decision rules triage the patient to low risk
    2. Indwelling Urinary Catheters (Foley Catheters)
      1. Limit use to monitoring urine output in critically ill patients, urine obstruction, perioperative state and End-Of-Life Care
      2. Avoid indwelling Urinary Catheter in stable, voiding patients
        1. Not indicated for urine output monitoring in stable patients (void into measure container)
        2. Not indicated for convenience
    3. Palliative Care and Hospice
      1. Engage Palliative Care and Hospice early when indicated in chronic disease or End-Of-Life Care
    4. Skin Abscess management
      1. Avoid antibiotics and wound cultures for uncomplicated skin and soft tissue abscesses
      2. Assumes definitive Incision and Drainage and appropriate follow-up
    5. Pediatric Dehydration Management
      1. Oral Rehydration Therapy should be the first-line intervetion in mild to moderate Pediatric Dehydration
      2. Intravenous replacement should be reserved for those who fail oral rehydration
    6. References
      1. http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/
  2. Precautions: Family Medicine
    1. Low Back Pain imaging
      1. Avoid imaging in the first 6 weeks in uncomplicated Low Back Pain without red flags
    2. Acute Sinusitis antibiotic management
      1. Avoid antibiotics in mild to moderate Acute Sinusitis until >7 days of symptoms or symptom worsening after initial improvement
    3. Osteoporosis Screening with DEXA Scan
      1. Delay DEXA Scan until age 65 years in women, 70 years in men unless Osteoporosis Risk Factors dictate otherwise
    4. Cardiac screening in asymptomatic, low risk patients
      1. Avoid cardiac screening (Electrocardiogram, stress test) in asymptomatic, low risk patients
    5. Cervical Cancer Screening indications (Pap Smear and HPV screening)
      1. Avoid Pap Smear in women under age 21 years or following Hysterectomy for benign cause
      2. Avoid Pap Smear in women over age 65 years who had prior adequate prior screening and not high risk for Cervical Cancer
      3. Avoid HPV screening (with or without cytology) in women under age 30 years
    6. Labor Induction and Cesarean Section scheduling
      1. Avoid scheduled Labor Induction or C-Section prior to 39 weeks unless medically indicated
    7. Carotid Stenosis screening
      1. Avoid Carotid Artery Stenosis screening in asymptomatic patients
    8. Otitis Media antibiotics
      1. Observation is the preferred protocol in children ages 2-12 years with non-severe Otitis Media symptoms, and other observation criteria met
    9. Pediatric UTI imaging
      1. Avoid Voiding Cystourethrogram (VCUG) in children ages 2-24 months, with first febrile Urinary Tract Infection (UTI)
    10. Prostate Cancer Screening
      1. Avoid universal Prostate Cancer Screening with Prostate-specific antigen (PSA) test or Digital Rectal Exam
      2. Prostate Cancer Screening when performed should be accompanied by Informed Consent of risks and benefits
    11. Scoliosis Screening
      1. Avoid screening asymptomatic teens for Idiopathic Scoliosis
    12. Oral Contraceptive Prescribing
      1. Blood Pressure measurements and medical history alone are sufficient to provide Oral Contraceptive prescriptions
      2. Avoid requiring pelvic exam or physical exam prior to writing for Oral Contraceptive medications
    13. References
      1. http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-family-physicians/
  3. Resources
    1. ABIM Choosing Wisely Site
      1. http://www.choosingwisely.org/doctor-patient-lists/

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