UMEM Educational Pearls

Title: Choosing Wisely in the ICU

Keywords: choosing wisely, icu, critical care (PubMed Search)

Posted: 10/21/2014 by Feras Khan, MD (Updated: 4/24/2024)
Click here to contact Feras Khan, MD

Choosing Wisely in the ICU

There is a general overuse of medical tests and treatments
This wastes healthcare resources
The Choosing Wisely Campaign was developed to have providers of different specialties choose medical services that should be questioned

The Critical Care Societies Collaborative came up with this list for ICU providers

1. Don’t order diagnostic tests at regular intervals (such as every day) but rather in response to specific clinical questions. Do you really need a daily INR check or CBC check in all ICU patients? Really?

2. Don’t transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 g/dl. See last week’s Pearl!

3. Don’t use parental nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay. TPN is the Cinnamon Toast Crunch of fungi.

4. Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. Use as little as possible when you can.

5. Don’t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort. Engage families early in the hospital stay regarding aggressive life-sustaining treatments. Get palliative care involved in the ED!

References

http://www.choosingwisely.org/doctor-patient-lists/critical-care-societies-collaborative-critical-care/

Crit Care Med. 2014 Nov;42(11):2437-8. doi: 10.1097/CCM.0000000000000696.

Choosing wisely® in critical care: maximizing value in the intensive care unit.

Angus DC¹, Deutschman CS, Hall JB, Wilson KC, Munro CL, Hill NS.