Pediatric Medical Overuse - Current Ways to Reduce Unnecessary Harm-Slides

Slides

Pdf Summary

The document "Pediatric Medical Overuse: Current Ways to Reduce Unnecessary Harm" by Nathan Money, DO, and Danni Liang, MD, addresses reducing low-value pediatric healthcare interventions to prevent patient harm, reduce costs, and improve equity.<br /><br />Key objectives include understanding healthcare value principles, applying them to common pediatric cases, and discussing current challenges in pediatric healthcare value. Overuse is defined as interventions without net patient benefit, overdiagnosis refers to identifying non-beneficial abnormalities, and misdiagnosis is inaccurate diagnosis.<br /><br />Examples discussed include:<br />1. Management of hypothermic infants, where evidence suggests observation without extensive workup is reasonable for well-appearing infants due to low infection risk.<br />2. Shortening antibiotic courses for pediatric urinary tract infections, referencing the SCOUT trial showing that shorter 5-day courses may be considered for children showing early improvement.<br />3. Post-hospitalization follow-up after bronchiolitis, where as-needed rather than routine scheduled follow-up may reduce healthcare utilization without increasing adverse outcomes.<br /><br />The concept of "deimplementation"—phasing out low-value interventions—is emphasized, considering evidence quality, practice prevalence, patient harm, costs, and equity implications. Addressing healthcare disparities is highlighted as critical since marginalized populations often experience amplified harms from overuse.<br /><br />Choosing Wisely recommendations for pediatric hospitalists include avoiding prolonged IV antibiotics, unnecessary hospitalization after negative cultures, phototherapy below treatment thresholds, broad-spectrum antibiotics for uncomplicated pneumonia, and IV antibiotics in well-appearing newborns with only sepsis risk factors.<br /><br />Additional areas of overuse noted include unnecessary melatonin, antiviral use, viral testing, procedures like G-tube placement, routine two-day birth stays, and proton pump inhibitor use.<br /><br />The presentation references current studies, ongoing trials, and encourages further education on reducing pediatric medical overuse to enhance quality, safety, cost-effectiveness, and equity in care. Contact and CME evaluation information is provided for learners wishing to engage further.

Keywords

pediatric medical overuse

low-value healthcare interventions

patient harm prevention

healthcare value principles

hypothermic infants management

shortened antibiotic courses

bronchiolitis follow-up

deimplementation strategies

healthcare disparities

Choosing Wisely recommendations