Could you Cut Costs in the Emergency Department? Survey

Could you Cut Costs in the Emergency Department?

In the most recent edition of the New England Journal of Medicine, Dr. Howard Brody challenged physicians to identify specialty-specific costly procedures and evaluations that should be eliminated or restricted based on current evidence-based medicine. He asks that each specialty group develop their own Top Five List. Put together, these lists could provide templates for practice guideline changes and the basis for substantial health care savings.

Emergency Physicians Monthly would like to take a step towards establishing rational, evidence-based standards. And that begins with your feedback. Thank you for your participation in this 3-minute survey.

1. Which of the following common X-ray and CT procedures would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply)

Which of the following common X-ray and CT procedures would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply) X-rays: Low back films in young, healthy patients with minor injuries

X-rays: Ankle films for patients who are excluded by the Ottawa ankle rules

X-rays: Knee films for patients with a twisting injury

X-rays: Nasal/facial films

X-rays: Rib xrays

CT: Renal colic in young, healthy patients with a presentation consistent with nephrolithiasis

CT: Minor head injury > 2 yrs of age with normal exam and someone to observe the patient

Other (please specify)

2. Which of the following medications and labs would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply)

Which of the following medications and labs would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply) Admissions: Social admits for the elderly

Intravenous fluids: Use hep lock only (no fluids) when the patient requires access, not hydration

Medications: "To go" pain medications during normal business hours

Medications: "To go" meds after normal business hours

Medications: First dose oral antibiotic during normal business hours

Labs: Blood cultures for outpatients

Labs: Urinalysis in young, healthy women with classic UTI symptoms

Labs: Amylase (when Lipase is available)

Labs: WBC for all diseases

Labs: Pt/INR and PTT in chest pain patients

Labs: Throat cultures for Strep

Other (please specify)

3. If emergency medicine had a Top Five List, what would it require for you to change your individual practice?

If emergency medicine had a Top Five List, what would it require for you to change your individual practice? High quality evidence based medicine

Specialty guideline

Clearly stated medical legal protection

Departmental modification of patient satisfaction expectations

Other (please specify)

4. If emergency medicine acted on its Top Five List what do you think would happen to your annual salary?

If emergency medicine acted on its Top Five List what do you think would happen to your annual salary? It would increase

It would stay the same

It would decrease by 5%

It would decrease greater than 10%

5. Would you be willing to give up a percentage of your salary to see real health care reform?

Would you be willing to give up a percentage of your salary to see real health care reform? Yes

If Yes, by what percentage?

1. The Bottom Five

1. Which of the following common X-ray and CT procedures would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply)

2. Which of the following medications and labs would be on your "Top Five List" for cutting waste in emergency medicine? (Check all that apply)

3. If emergency medicine had a Top Five List, what would it require for you to change your individual practice?

4. If emergency medicine acted on its Top Five List what do you think would happen to your annual salary?

5. Would you be willing to give up a percentage of your salary to see real health care reform?