Choosing Wisely For Critical Care: The Next Five

Jerry J Zimmerman¹, Lori A Harmon², Pamela L Smithburger³, Darlene Chaykosky⁴, Alan C Heffner⁵, Marilyn Hravnak⁶, Jason M Kane⁷, Joshua B Kayser⁸, Meghan B Lane-Fall⁹, Renee I Matos¹⁰, Riza V Mauricio¹¹, David J Murphy¹², Michael Nurok¹³, Anita J Reddy¹⁴, Eric Ringle¹⁵, Edward G Seferian¹⁶, Norma M Smalls-Mantey¹⁷, Kathleen B To¹⁸, Lewis J Kaplan¹⁹

Affiliations

¹ Department of Pediatrics, Seattle Children's Hospital, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.
² Society of Critical Care Medicine, Mount Prospect, IL.
³ University of Pittsburgh School of Pharmacy, Pittsburgh, PA.
⁴ Enterprise Pharmacy, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
⁵ Department of Emergency Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC.
⁶ School of Nursing, University of Pittsburgh, Pittsburgh, PA.
⁷ Department of Pediatrics, University of Chicago, Comer Children's Hospital, Chicago, IL.
⁸ Departments of Medicine and Medical Ethics and Heath Policy, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁹ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
¹⁰ San Antonio Military Medical Center, San Antonio, TX.
¹¹ The University of Texas MD Anderson Cancer Center, Department of Pediatrics, University of Texas, Houston, TX.
¹² Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
¹³ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
¹⁵ Cerner Corporation, Kansas City, MO.
¹⁶ Departments of Pediatrics and Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁷ Department of Surgery, Howard University Hospital, Washington, DC.
¹⁸ Division of Surgical Critical Care R. Adams Cowley Shock Trauma Center, Baltimore, MD.
¹⁹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

PMID: 33555779
DOI: 10.1097/CCM.0000000000004876

Review

Choosing Wisely For Critical Care: The Next Five

Jerry J Zimmerman et al. Crit Care Med. 2021.

. 2021 Mar 1;49(3):472-481.

doi: 10.1097/CCM.0000000000004876.

Authors

Affiliations

¹ Department of Pediatrics, Seattle Children's Hospital, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.
² Society of Critical Care Medicine, Mount Prospect, IL.
³ University of Pittsburgh School of Pharmacy, Pittsburgh, PA.
⁴ Enterprise Pharmacy, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
⁵ Department of Emergency Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC.
⁶ School of Nursing, University of Pittsburgh, Pittsburgh, PA.
⁷ Department of Pediatrics, University of Chicago, Comer Children's Hospital, Chicago, IL.
⁸ Departments of Medicine and Medical Ethics and Heath Policy, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁹ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
¹⁰ San Antonio Military Medical Center, San Antonio, TX.
¹¹ The University of Texas MD Anderson Cancer Center, Department of Pediatrics, University of Texas, Houston, TX.
¹² Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
¹³ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
¹⁵ Cerner Corporation, Kansas City, MO.
¹⁶ Departments of Pediatrics and Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁷ Department of Surgery, Howard University Hospital, Washington, DC.
¹⁸ Division of Surgical Critical Care R. Adams Cowley Shock Trauma Center, Baltimore, MD.
¹⁹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

PMID: 33555779
DOI: 10.1097/CCM.0000000000004876

Abstract

Objectives: To formulate new "Choosing Wisely" for Critical Care recommendations that identify best practices to avoid waste and promote value while providing critical care.

Data sources: Semistructured narrative literature review and quantitative survey assessments.

Study selection: English language publications that examined critical care practices in relation to reducing cost or waste.

Data extraction: Practices assessed to add no value to critical care were grouped by category. Taskforce assessment, modified Delphi consensus building, and quantitative survey analysis identified eight novel recommendations to avoid wasteful critical care practices. These were submitted to the Society of Critical Care Medicine membership for evaluation and ranking.

Data synthesis: Results from the quantitative Society of Critical Care Medicine membership survey identified the top scoring five of eight recommendations. These five highest ranked recommendations established Society of Critical Care Medicine's Next Five "Choosing" Wisely for Critical Care practices.

Conclusions: Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care. These recommendations supplement the initial critical care recommendations from the "Choosing Wisely" campaign.

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Conflict of interest statement

Dr. Zimmerman’s institution received funding from the National Institutes of Health (NIH), Biomedical Advanced Research and Development Authority, and Immunexpress, and he received funding from Elsevier Publishing and the Society of Critical Care Medicine (SCCM). Dr. Zimmerman also disclosed that SCCM provided significant administrative support for the Next Five Choosing Wisely for Critical Care Taskforce, but this was not directed toward specific individuals or institutions. Dr. Chaykosky received funding from Edwards Lifesciences and Medline Industries. Dr. Lane-Fall’s institution received funding from NIH/National Heart, Lung, and Blood Institute; she received funding from Anesthesia Patient Safety Foundation (Board of Directors); and she received support for article research from the NIH. Dr. Matos disclosed that she is active duty military. Dr. Nurok received funding from AvantGarde Health. Dr. Kaplan received funding from SCCM (President). The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: Estimated costs and potential for savings. JAMA. 2019; 322:1501–1509
1. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012; 307:1513–1516
1. Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: How might more be worse? JAMA. 1999; 281:446–453
1. Moriates C, Shah NT, Arora VM. First, do no (financial) harm. JAMA. 2013; 310:577–578
1. Casarett D. The science of choosing wisely–Overcoming the therapeutic illusion. N Engl J Med. 2016; 374:1203–1205

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Choosing Wisely For Critical Care: The Next Five

Affiliations

Choosing Wisely For Critical Care: The Next Five

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical