The overuse of antibiotics in both medicine and livestock has been making headlines recently, and patients and community members may be turning to you with questions. The American Hospital Association, in fact, is already addressing the public health and national security threat posed by antibiotic-resistant bacteria. AHA participated in the recent White House forum on antibiotic stewardship and shared the toolkit it developed with six national partners to help hospitals and systems enhance their antimicrobial stewardship programs.

The toolkit was the outgrowth of a larger initiative aimed at using medical resources appropriately. Two years ago, in a response to the AHA board of trustees’ work on improving care while achieving a sustainable level of spending (see “Ensuring a Healthier Tomorrow” at, the AHA’s Physician Leadership Forum released a white paper that identified areas in which hospitals, in partnership with their clinical staff and patients, should look to reduce nonbeneficial care. They are:

• appropriate blood management in inpatient services

• appropriate antimicrobial stewardship

• reducing inpatient admissions for ambulatory-sensitive conditions (for example, lower back pain, asthma)

• appropriate use of elective percutaneous coronary intervention

• appropriate use of the intensive care unit for imminently terminal illness (including encouraging early intervention and discussion about priorities for care in the context of progressive disease)

Since then, PLF has developed toolkits with partner groups on the first four of the five topics. The latest toolkit addresses elective percutaneous coronary intervention for patients with acute heart disease. It includes resources for hospital and system leaders, clinicians and patients, including case examples, reports, toolkits, self-assessments and links to webinars.

All of the toolkits are available at no charge at appropriateuse. There you’ll also find the original white paper on all five recommendations and a discussion guide your board, clinicians and community can use to explore the issue of appropriate use.

I encourage you to share this paper with your board. By reducing nonbeneficial care — care that increases costs without a concomitant increase in value — we can move closer toward achieving the Triple Aim. Studies show that when providers are well-informed on appropriate care options and those options are fully discussed with engaged patients, health care outcomes improve at reduced costs.

Fred Gattas Jr. ( is COG chair and a trustee of St. Jude Children’s Research Hospital in Memphis, Tenn.