Implementing Choosing Wisely recommendations in the ICU can help reduce unnecessary testing, treatments, and associated costs.
Encourages ICU adoption of education and prompts to reduce overtesting; extends de-implementation evidence to critical care.
campaign. The campaign aims to promote the use of judicious testing and decrease unnecessary treatment measures in the ICU. The CCSC outlines five specific recommendations for reducing unnecessary testing in the ICU. First, reduce the use of daily or regular interval diagnostic testing. Second, do not transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dl. Third, do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of ICU stay. Fourth, do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. Finally, do not continue life support for patients at high risk of death without offering patients and their families the alternative of comfort focused care. A number of strategies can be used to reduce unnecessary testing in the ICU, including educational campaigns, audit and feedback, and implementing prompts in the electronic ordering system to allow only acceptable indications when ordering routine testing. Greater awareness of the lack of outcome benefit and associated costs can prompt clinicians to be more mindful of ordering tests and procedures in order to reduce unnecessary testing in the ICU.
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Kleinpell et al. (2018) conducted a review in Critical illness requiring intensive care. Choosing Wisely recommendations was evaluated. Implementing Choosing Wisely recommendations in the intensive care unit through strategies like clinician education and electronic ordering prompts can reduce unnecessary laboratory and X-ray testing.