Choosing Wisely in the ICU: 2021

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Picture of Colin McCloskey
Colin McCloskey
EM Intensivist at University Hospitals Cleveland Medical Center

The Pre-brief

It is a common criticism of the US healthcare system that its expense does not deliver appropriate outcomes. Value in healthcare achieves outcomes that matter to patients relative to the cost of attaining those patient-centered outcomes. An effort to eliminate wasteful practices provides an opportunity to promote value. The “Choosing WIsely” Campaign is one such effort. It challenged all medical specialties to confront wasteful practices that did not add value to patient care and move to eliminate them.  In 2014, the Critical Care Societies Collaborative answered that call and identified an initial five practices to eliminate. Let’s revisit these briefly:

Despite being seven years old, some of these recommendations have yet to saturate most ICUs (I’m looking at you, daily labs). 

The Society for Critical Care Medicine (SCCM) taskforce was constructed to choose the next five practices to eliminate or improve upon to drive value in the intensive care unit.

What do you think? Reasonable? Achievable?

The Debrief

  • Achieving value in healthcare involves eliminating wasteful practices that do not contribute to patient-centered outcomes or can otherwise cause harm 
  • The original “Choosing Wisely” practices are reasonable and evidenced-based, though compliance has been challenging
  • The next five “Choosing Wisely” practices demand the cessation of unnecessary catheters, mechanical ventilation, and antibiotics. They encourage early mobilization and patient-centered goals of care.

References

  1. Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harvard business review, 91(12), 24-24.
  2. Halpern SD, Becker D, Curtis JR, et al; Choosing Wisely Taskforce; American Thoracic Society; American Association of Critical-Care Nurses; Society of Critical Care Medicine: An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/ Society of Critical Care Medicine policy statement: The choosing Wisely® top 5 list in critical care medicine. Am J Respir Crit Care Med 2014; 190:818–826
  3. Kleinpell, R., Sessler, C. N., Wiencek, C., & Moss, M. (2019). Choosing wisely in critical care: results of a national survey from the critical care societies collaborative. Critical care medicine, 47(3), 331-336.
  4. Zimmerman, J. J., Harmon, L. A., Smithburger, P. L., Chaykosky, D., Heffner, A. C., Hravnak, M., … & Kaplan, L. J. (2021). Choosing Wisely For Critical Care: The Next Five. Critical Care Medicine.

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