1. Emergency Physician Attitudes and Knowledge of ACEP’s Choosing Wisely Recommendations Thomas Nguyen, MD 1, Lynne D. Richardson, MD 2, Jeremiah D. Schuur, MD, MHS 3, Beicer C. Tapia, MA 2, Michelle P. Lin, MD, MPH, SM 1 BACKGROUND METHODS DATA In October 2015 we conducted a cross-sectional survey of U.S. Emergency Physicians at a large, national professional meeting to assess practice patterns, attitudes and knowledge of CW recommendations. (see Table 1). A separate section tested EP’s knowledge of the CW recommendations. A 41-item survey instrument was iteratively developed through review by content experts and pilot testing. In 2013, ACEP joined the Choosing Wisely (CW) campaign to reduce unnecessary tests and procedures in emergency medicine (see ACEP’s Choosing Wisely Campaign table). Emergency physician (EP) attitudes and knowledge of the CW campaign are unknown. The purpose of this study is to report EP attitudes and knowledge of the CW campaign in actual clinical practice. RESULTS We approached 819 EPs; 755 (91.6%) completed the survey. Two-thirds (68%) of respondents were male; 47% practiced in academic settings and 47% in community settings. The range of EPs who frequently or always performed a test or procedure despite CW recommendations not to do so was 5.6 to 29.9% (Table 2). The most frequently performed test was head CT for minor head injury in patients deemed low-risk by decision rules (29.9%), followed by antibiotics for sinusitis (26.9%). The most infrequent practices were Foley catheter for patients who can void and lumbar X-ray for non-traumatic back pain. EPs reported patient and family expectations as the most important reason for ordering head CT after minor head injury, imaging for non-traumatic low back pain, and antibiotics for sinusitis; however, concern for serious diagnosis was the most important reason for performing CT chest for patients with normal D-dimer and CT abdomen for recurrent uncomplicated renal colic. (Table 3). For 9 of 10 recommendations, more EPs cited “concern for serious diagnosis” as the most important reason than “reduce malpractice risk.” Few (5.6%) respondents were able to correctly identify 5 out of 5 CW recommendations. A majority (65%) of EPs are more comfortable discussing unnecessary tests and procedures with patients as a result of the CW campaign, 55% have reduced unnecessary tests and procedures as a result of CW, and 53% of aware of efforts in their ED or hospital to promote the CW recommendations (Table 4). CONCLUSIONS EPs continue to report performing avoidable tests and procedures despite CW recommendations. Although most EPs are not aware of all recommendations, the CW campaign has promoted discussions of unnecessary tests and procedures between EPs and patients. More research is needed to identify effective ways to change behavior and improve quality. Table: ACEP’s Choosing Wisely Campaign 1 Mount Sinai Beth Israel, NY, 2 Mount Sinai Medical Center, NY, 3 Harvard University/Brigham and Women’s, Boston MA

2. Emergency Physician Attitudes and Knowledge of ACEP’s Choosing Wisely Recommendations Thomas Nguyen, MD, Lynne D. Richardson, MD, Jeremiah D. Schuur, MD, MHS, Beicer C. Tapia, MA, Michelle P. Lin, MD, MPH, SM Page 2 DATA CONTINUED REFERENCES CONCLUSIONS EPs continue to report performing avoidable tests and procedures despite CW recommendations. Although most EPs are not aware of all recommendations, the CW campaign has promoted discussions of unnecessary tests and procedures between EPs and patients. More research is needed to identify effective ways to change behavior and improve quality. Table 3. Reasons For Unnecessary Testing Table 4. Agreement With the Following 1. Hemal K. Kanzaria, MD, MSHPM, Jerome R. Hoffman, MA, MD, Marc A. Probst, MD. Et al. Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging. ACADEMIC EMERGENCY MEDICINE 2015;22:390–398 © 2015 by the Society for Academic Emergency Medicine. 2. www.choosingwisely.org/.../american-college-of-emergency-physicians/ Table 2. Self-Reported Practice Patterns Table 1. Characteristics of Participating Physicians (n=755)