Almost three quarters of physicians surveyed in the U.S. admit to ordering at least one unnecessary test, procedure or treatment every week. In Australasia, EVOLVE is the RACP's initiative to minimise clinical practices that aren't supported by the current evidence base, and stems from the international healthcare campaign Choosing Wisely.

EVOLVE has recently published a list of the top five practices in general paediatrics that need to be pulled back. Developed in consultation with Fellows from the RACP Paediatrics and Child Health Division, its recommendations are:

1. Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.
2. Do not routinely undertake chest radiography for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children.
3. Do not routinely order chest radiography for the diagnosis of asthma in children.
4. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
5. Do not routinely order abdominal radiography for the diagnosis of non-specific abdominal pain in children.

This episode of Pomegranate explores the rationale behind these recommendations and some alternatives that paediatricians can adopt to improve their practice.

Guests
Prof Harriet Hiscock FRACP (Director, Royal Children's Hospital Health Services Research Unit; Director, Australian Paediatric Research Network)
Dr Sarah Dalton FRACP (President, RACP Paediatrics and Child Health Division; Clinical Leader, NSW Agency for Clinical Innovation)
Dr Hamish McCay FRACP (Paediatrics Clinical Director, Waikato Hospital).

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and the Sea') and Cory Gray ('Down to the Street'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Prof Peter Procopis. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.