​The American College of Emergency Physicians (ACEP) has added five new items to its list of tests and procedures that should be questioned before they are ordered as part of the Choosing Wisely campaign. Following on an initial list of five items announced in October 2013, the new items are: computed tomography (CT) of the head in asymptomatic adult patients in the emergency department (ED) with syncope, insignificant trauma and a normal neurological evaluation; CT pulmonary angiography in ED patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer; lumbar spine imaging in the ED for adults with non-traumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition (such as vertebral infection, cauda equine syndrome, or cancer with bony metastasis); prescribing antibiotics in the ED for uncomplicated sinusitis; and CT of the abdomen and pelvis in young otherwise healthy ED patients with known histories of kidney stones, or ureterolithiasis, presenting with symptoms consistent with uncomplicated renal colic. The new items were announced October 27, 2014, at ACEP's annual meeting in Chicago, Illinois. Additional coverage is available in an October 28, 2014, Forbes article.

HRC Recommends: Overuse of tests and procedures—a threat to the effective and efficient use of healthcare—has been attributed to a mix of factors, including defensive medicine and patient preference. Lists such as those issued as part of the Choosing Wisely campaign can provide some guidance; risk managers may wish to forward the Choosing Wisely lists to appropriate departments. It is sometimes hard to determine whether a test or a procedure is necessary. However, discussion between patients and physicians about the risks and benefits of tests and procedures and the patient's goals can lead to treatment that is both medically appropriate and in line with the patient's wishes.