San Francisco Medical Center Adapts Choosing Wisely List for Waste Reduction Campaign



A University of California at San Francisco (UCSF) quality initiative targeting waste and overuse of healthcare resources plans to focus on four of five questionable treatments identified by the Society of Hospital Medicine for the ABIM Foundation’s Choosing Wisely campaign. The UCSF Division of Hospital Medicine’s High Value Care Committee grew out of efforts to operationalize a curriculum for teaching medical trainees about the actual costs of treatments they commonly order. UCSF hospitalist Christopher Moriates, MD, developed the curriculum when he was a resident.

The committee brings together physicians, who have historically focused on quality improvement, and finance administrators, who focus on cost reduction. Together they are pursuing performance improvement projects serving both goals, Dr. Moriates says. The committee identified six waste targets initially and has already reduced the use of ionized calcium blood tests, formerly administered to numerous patients at UCSF Medical Center whether they needed it or not, and the unnecessary use of nebulizers, by more than half.

“When the Choosing Wisely list came out, it fit with what we were doing, although I wasn’t sure that these things were problems for us,” Dr. Moriates explains.

The data, however, show that UCSF was significantly better than its peers for only one of the five treatments on the list: utilization of Foley catheters and corresponding rates of catheter-related urinary tract infections. The committee is focused on more judicious, evidence-based ordering of the other Choosing Wisely treatments: medications for stress ulcer prophylaxis, blood transfusions, continuous telemetry monitoring outside of the ICU, and certain lab tests.

Dr. Moriates recommends the Choosing Wisely list for other hospitals and hospitalists starting to tackle unnecessary medical treatments and tests. Data is essential to these efforts, he says, stressing the need to consider not just utilization rates but actual dollars spent.

“That shouldn’t be a major hurdle, given hospital information technology, but often it is,” he says, adding that waste initiatives are more successful when they are led by frontline champions, rather than just assigned by the department’s chair.

Read more about Dr. Moriates’ waste control efforts in HealthLeaders Media, and learn about another waste reduction strategy called the Teaching Value Project at www.teachingvalue.org.1


1. Clark C. How hospital practices are trimmed at UCSF. HealthLeaders Media. August 8, 2013. Available at: http://www.healthleadersmedia.com/content/QUA-295035/How-Hospital-Practices-are-Trimmed-at-UCSF##. Accessed September 21, 2013.

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