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Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.
Choosing Wisely®
Choosing Wisely®
The COVID-19 pandemic amplifies the need for early goals of care discussions. Mortality rates range higher with acute respiratory distress syndrome from COVID-19, compared with other etiologies, and is associated with extended intensive care unit stays.The harms extend beyond the patient and families to our HCWs through psychological distress and heightened exposure from aerosolization during resuscitation. Advance care planning should center on the values and preferences of the patient. Rather ...
ver más ... 2020Avoid in-person evaluations and promote virtual communication, unless necessary during the COVID-19 pandemic.
Choosing Wisely®
Choosing Wisely®
To minimize HCW exposure to COVID-19 and optimize infection control, the CDC recommends the use of telemedicine when possible.Telemedicine refers to the use of technology to support clinical care across some distance, which includes video visits and remote clinical monitoring. At the time of writing, the Centers for Medicare & Medicaid Services had waived the rural site of care requirement for Medicare beneficiaries, granted 49 Medicaid waivers to states to enhance flexibility, and (at least ...
ver más ... 2020Do not use posteroanterior and lateral chest X-ray as initial imaging. Use a portable chest X-ray instead.
Choosing Wisely®
Choosing Wisely®
The CDC does not currently recommend diagnosing COVID-19 by chest X-ray (CXR). When used appropriately, CXR can provide information to support a COVID-19 diagnosis and rule out other etiologies that cause respiratory symptoms. Posteroanterior (PA) and lateral CXR are more sensitive than portable CXR for detecting pleural effusions, and lateral CXR is needed to examine structures along the axis of the body. Portable CXR also may cause the heart to appear magnified and the mediastinum widened, ...
ver más ... 2020Do not use bronchodilators unless there is active obstructive airway disease, and if needed, use metered dose inhalers instead of nebulizers.
Choosing Wisely®
Choosing Wisely®
We do not recommend using bronchodilators to treat COVID-19 symptoms unless patients develop acute bronchospastic symptoms of their underlying obstructive airway disease. When needed, use metered dose inhalers (MDIs), if available, instead of nebulizers because the latter potentiates aerosolization that could lead to higher risk of spreading the infection. The risk extends to respiratory technicians and nurses who administer the nebulizer, as well as other HCWs who enter the room during or ...
ver más ... 2020Do not obtain non urgent labs in separate blood draws if they can be batched together.
Choosing Wisely®
Choosing Wisely®
This recommendation expands on the original Society of Hospital Medicine Choosing Wisely recommendation: Don’t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability. Aside from patient harms such as pain and hospital-acquired anemia, the risk of exposure to HCWs who perform phlebotomy (phlebotomists, nurses, and other clinicians), as well as staff who transport, handle, and process the bloodwork in the lab, must be minimized. Most prior ...
ver más ... 2020