CHEST Guidelines-Choosing-Wisely-in-Critical-Care

Choosing-Wisely-in-Critical-Care_chest

Pdf Summary

The provided document is an editorial from the November 2014 issue of the journal "CHEST" discussing the "Choosing Wisely" campaign, specifically in the context of critical care medicine. The campaign addresses issues of overuse and underuse of medical tests and treatments, aiming to optimize the use of healthcare resources while enhancing patient outcomes. The campaign was inspired by medical ethicist Howard Brody, who advocated for professional societies to create lists identifying unnecessary medical services that do not provide meaningful benefits to patients.<br /><br />In response, the Critical Care Societies Collaborative (CCSC), which includes four major societies: the American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine, developed a list for critical care medicine that reflects a multiprofessional approach. The list identifies five services often questioned for their clinical utility: <br />1. Routine ordering of diagnostic tests without specific clinical indications.<br />2. Transfusion of red blood cells in stable patients with a hemoglobin concentration above 7 g/dL.<br />3. Early use of parenteral nutrition in adequately nourished patients.<br />4. Deep sedation for mechanically ventilated patients without indication or daily reduction.<br />5. Continuation of life support without offering comfort-focused care for patients with poor prognoses.<br /><br />The editorial emphasizes the need for ongoing evaluation of the campaign's effectiveness in reducing healthcare costs and suggests measures for promoting compliance with the recommendations. The authors caution against rigid enforcement that could lead to underutilization and underscore the importance of adapting care based on individual patient needs.<br /><br />The discussion underscores the complex factors influencing inappropriate testing and treatment, advocating for an inclusive approach that incorporates input from all healthcare professionals, including nurses, to strengthen and broaden the scope of the Choosing Wisely lists.

Keywords

Choosing Wisely

critical care medicine

healthcare resources

patient outcomes

Critical Care Societies Collaborative

unnecessary medical services

diagnostic tests

red blood cell transfusion

parenteral nutrition

life support