Hart Joanna, Halpern Scott D
aDivision of Pulmonary, Allergy and Critical Care Medicine, Leonard Davis Institute of Health Economics and Fostering Improvement in End-of-Life Decision Science (FIELDS) Program at the Perelman School of Medicine bCenter for Epidemiology and Biostatistics and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Opin Crit Care. 2014 Dec;20(6):662-7. doi: 10.1097/MCC.0000000000000146.
Default options dramatically influence the behavior of decision makers and may serve as effective decision support tools in the ICU. Their use in medicine has increased in an effort to improve efficiency, reduce errors, and harness the potential of healthcare technology.
Defaults often fall short of their predicted influence when employed in critical care settings as quality improvement interventions. Investigations reporting the use of defaults are often limited by variations in the relative effect across sites. Preimplementation experiments and long-term monitoring studies are lacking.
Defaults in the ICU may help or harm patients and clinical efficiency depending on their format and use. When constructing and encountering defaults, providers should be aware of their powerful and complex influences on decision making. Additional evaluations of the appropriate creation of healthcare defaults and their resulting intended and unintended consequences are needed.
默认选项会极大地影响决策者的行为，并且在重症监护病房（ICU）中可作为有效的决策支持工具。为提高效率、减少错误并发挥医疗技术的潜力，默认选项在医学领域的应用有所增加。
在重症监护环境中作为质量改进干预措施使用时，默认选项往往达不到预期的影响。报告默认选项使用情况的调查常常受到各地点相对效果差异的限制。缺乏实施前实验和长期监测研究。
ICU中的默认选项可能有助于或损害患者及临床效率，这取决于其形式和用途。在构建和遇到默认选项时，医疗服务提供者应意识到它们对决策有着强大而复杂的影响。需要对医疗默认选项的适当创建及其产生的预期和非预期后果进行更多评估。
