1. 1

    Avoid medication-related harm  in older patients (>65 years) receiving 5 or more regularly used medicines by performing a complete medication review and deprescribing whenever appropriate

  2. 2

    Don’t request daily full blood counts, erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) as measures of response to antibiotic treatment if patients are clinically improving 

  3. 3

    Once patients have become afebrile (non-feverish) and are clinically improving, don’t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if they are tolerant of oral antibiotics

  4. 4

    Don’t request Holter monitoring, carotid duplex scans, echocardiography, electroencephalograms (EEGs) or telemetry in patients with first presentation of uncomplicated syncope and no high risk features   

  5. 5

    Don’t request computerised tomography pulmonary angiography (CTPA) as first-choice investigation in non-pregnant adult patients with low risk of pulmonary thromboembolism (PTE) by Wells’ score (score <= 4) ; imaging can be avoided in low risk patients if  D-dimer test is negative after adjusting for age   

How this list was developed

A panel of IMSANZ members produced an initial list of 32 low value tests, treatments and management decisions frequently encountered in general medicine services. 350 members of a working group comprising approximately 50 general physicians as well as nurses and allied health professionals were asked to rank the  items in terms of priority and  nominate additional items. Based on their responses, the list was condensed to 15 items including three which were not previously listed. Following further discussion, this was reduced to a list of 10.

Recommendations on ‘what not to do’ were formulated around these 10 items and a summary of the evidence for each recommendation was prepared. An online survey was sent to all IMSANZ members asking respondents to assign a score from 1 to 5 for each recommendation on three criteria (evidence, frequency, and patient harm and cost).  The survey attracted 182 respondents from all across Australia and New Zealand, which was a response rate of 26%. The five with the highest average total scores were confirmed as the final list.

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