One energetic hospitalist, lamenting a "vast culture of overuse and waste," is working with a team to rid his hospital of some unnecessary operational habits that evidence says should be halted.
What can the iCal, a $20 calcium blood test previously administered to nearly all University of California at San Francisco Medical Center patients—whether they needed it or not—teach hospitals about inappropriate care and waste?
A huge amount, says Christopher Moriates, MD, assistant clinical professor of UCSF's division of hospital medicine.
Just one year out of residency, this energetic hospitalist is trying to change much about the culture of his acute care world, not just with peer education about this largely worthless test, but about several other operational habits that evidence says hospitals should break. UCSF stopped doing iCals on all patients about just over a year ago.
Moriates, 31, has had nearly a dozen articles published in national medical journals such as JAMA and Health Affairs, and in textbooks, and is an active member of his professional society in hospitalist medicine.
"It always drove me crazy to see all the things we did in the hospital that just didn't seem to make any sense, and the vast culture of overuse and waste," Moriates explains.
As he and some colleagues "began to review cases and identify the gaps between the evidence base and our practices, it was a natural extension for me to start thinking about how we operationalize these ideals, and start to tackle the rampant overuse and unnecessary testing in hospitals."