NYC Health + Hospitals announced on March 16, that it has adopted the American Board of Internal Medicine (ABIM) Foundation guidelines, system-wide, to further reduce the potential spread of COVID-19, and keep staff and patients safe during the pandemic.

 

The COVID-19 ‘Choosing Wisely’ guidelines advise healthcare providers on eliminating unnecessary testing and treatment in an effort to reduce exposure to COVID-19. The guidelines also incorporate specific, evidence-based recommendations clinicians should consider to utilize limited resources wisely, such as blood transfusions.

 

The recommendations adopted by NYC Health + Hospitals were decided on through an internal survey and dialogue with clinicians and safety officers throughout the system. NYC Health + Hospitals officials said the guidelines will help clinicians choose paths of care that are truly necessary, and are free from harm to the patient.

 

Hyung (Harry) Cho, MD is NYC Health + Hospitals chief value officer and said at NYC Health + Hospitals, the team doesn’t believe in just following the status quo standard of care for patients, but instead, question what they consider the norm as the hospital system continues to make healthcare safer, more convenient, and more efficient for patients. “These five, first recommendations are just the beginning for our ‘Choosing Wisely’ partnership,” he said. “We look forward to further collaborating with ABIM [Foundation] and shifting some norms of care.”

 

Mona Krouss MD is the NYC Health + Hospitals patient safety officer and said that the “Choosing Wisely” recommendations help guide clinicians to maximize benefits for patients, while reducing unnecessary harm and discomfort. “We’re happy for the opportunity to work with colleagues as part of the ABIM Foundation who have the same, patient-centered, value-based mission in mind to develop this guidance and further fulfill that mission,” she said.

 

The five adopted ‘Choosing Wisely’ ABIM Foundation recommendations include:

• avoiding tracheal intubation based solely on oxygen requirement, and instead considering the trajectory of deterioration, and candidacy for less invasive ventilation or proning [the process of turning a patient with precise, safe motions from their back onto their abdomen (stomach) so the individual is lying face down];
• not routinely placing central lines (like an IV) as an alternative to intravenous therapy and if a central line is necessary, considering removal or replacement to reduce potential for infection;
• reducing routine daily laboratory testing if a patient’s clinical labs are stable, and avoiding non-urgent labs in separate blood draws if they can be batched together;
• not ordering routine, daily, chest X-rays in patients with COVID-19; and
• not using bronchodilators, medications that relax muscle bands that tighten around the airways, unless there is active obstructive airway disease.

 

Council Member Carlina Rivera, who represents Manhattan’s District 2, and who is chair of the City Council Committee on Hospitals, said she commended NYC Health + Hospitals on its adoption of the recommendations. A vocal critic of the handling of the COVID-19 crisis by State and City during previous COVID-19-related hearings, Rivera said, “These new guidelines will not only protect our hospitals’ doctors, nurses, administrators and staff, but will also enable and encourage safe pathways of care for patients as we continue to fight the pandemic.”

 

NYC Health + Hospitals officials said the ‘Choosing Wisely’ ABIM Foundation recommendations have been shared with the system’s executive leadership and clinical departmental leadership, system-wide, so that all can take advantage of figuring out what tests and procedures may be appropriate for individual patients.

 

The initial ‘Choosing Wisely’ COVID-19 recommendations, written by Cho and Krouss were published in June 2020 in the Journal of Hospital Medicine.

 

NYC Health + Hospitals’ Office of Quality & Safety further refined these recommendations for the system’s use, which involved a systemwide survey, a review of the literature, the strength of clinical evidence, the goal of avoiding patient harm, and the potential for avoiding staff harm.

 

Norwood News reached out to NYC Health + Hospitals for comment on these new recommendations. While acknowledging that, obviously, COVID-19 was novel when it first emerged last year, and taking into account that hospitals all around the world were, very clearly, trying their best to identify what type of care, and which treatments worked best on COVID patients, we asked NYC Health + Hospitals if there had been any internal disagreement among doctors, at that time, within the hospital system on best practices, or within Bronx-based, NYC Health + Hospitals locations, and if so, how decisions were made on which treatments and practices to employ.

 

We were informed that people can learn more about how the five COVID-related recommendations were decided upon based on the broader list [of recommendations] included in this story, as well as on the broader “Choosing Wisely” initiative from the ABIM Foundation, outlined here. “These five initial recommendations were the ones that were voted on the most by clinical leads, so there wasn’t any ‘disagreements,’ and we hope to continue to expand the recommendations appropriately and timely,’ the NYC Health + Hospitals statement read.

 

We also asked the American Board of Internal Medicine Foundation what they had recommended, in terms of COVID care guidelines during the early stages of the pandemic, and asked if it had adjusted its position from previously employed practices, in the meantime.  We did not receive an immediate response.