Vanderbilt University School of Nursing, Nashville, TN.
Society of Critical Care Medicine, Mt. Prospect, IL.
Crit Care Med. 2019 Mar;47(3):331-336. doi: 10.1097/CCM.0000000000003496.
Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation's Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess how critical care clinicians were implementing the Critical Care Societies Collaborative Choosing Wisely recommendations in clinical practice.
Descriptive survey methodology with use of Research Electronic Data Capture (https://projectredcap.org/) sent via email newsletter blast or to individual emails of the 150,000 total members of the organizations.
National survey.
ICU physicians, nurses, advanced practice providers including nurse practitioners and physician assistants, and pharmacist members of four national critical care societies in the United States.
None.
A six-question survey assessed what Choosing Wisely recommendations had been implemented in ICU settings and if the impact was assessed. A total of 2,520 responses were received from clinicians: nurses (61%; n = 1538), physicians (25.9%; n = 647), advanced practice providers (10.5%; n = 263), and pharmacists (2.1%; n = 52), reflecting a 1.6% response rate of the total membership of 150,000 clinicians. Overall, 1,273 respondents (50.6%) reported they were familiar with the Choosing Wisely campaign. Respondents reported that Choosing Wisely recommendations had been integrated in a number of ways including being implemented in clinical care (n = 817; 72.9%), through development of a specific clinical protocol or institutional guideline (n = 736; 65.7%), through development of electronic medical record orders (n = 626; 55.8%), or with integration of longitudinal tracking using an electronic dashboard (n = 213; 19.0%). Some respondents identified that a specific quality improvement initiative was developed related to the Choosing Wisely recommendations (n = 468; 41.7%), or that a research initiative had been conducted (n = 156; 13.9%).
The results provide information on the application of the Choosing Wisely recommendations to clinical practice from a small sample of critical care clinicians. However, as only half of the respondents report implementation, additional strategies are needed to promote the Choosing Wisely recommendations to make impactful change to improve care in ICU settings.
在 ICU 环境中，住院患者的检查、治疗和程序过度使用很常见。美国内科医师学院基金会的明智选择运动要求专业协会确定专科护理实践中过度使用的来源。本研究的目的是评估重症监护临床医生如何在临床实践中实施重症监护协会协作明智选择建议。
使用 Research Electronic Data Capture（https://projectredcap.org/）通过电子邮件新闻稿或向四个美国国家重症监护协会的 150,000 名成员的个人电子邮件发送的描述性调查方法。
全国性调查。
美国 ICU 医生、护士、高级执业护士，包括执业护士和医师助理，以及药师。
无。
一项六问题调查评估了哪些明智选择建议已在 ICU 环境中实施，以及是否评估了其影响。从临床医生那里收到了 2520 份回复：护士（61%；n = 1538）、医生（25.9%；n = 647）、高级执业护士（10.5%；n = 263）和药师（2.1%；n = 52），反映了总会员人数的 1.6%的回复率为 150,000 名临床医生。总的来说，1273 名受访者（50.6%）表示他们熟悉明智选择运动。受访者报告说，明智选择建议已通过多种方式整合到临床护理中，包括实施临床护理（n = 817；72.9%），制定特定的临床方案或机构指南（n = 736；65.7%），制定电子病历医嘱（n = 626；55.8%），或通过使用电子仪表板进行纵向跟踪进行整合（n = 213；19.0%）。一些受访者确定与明智选择建议相关的特定质量改进计划已制定（n = 468；41.7%），或已开展研究计划（n = 156；13.9%）。
这些结果提供了有关重症监护临床医生将明智选择建议应用于临床实践的信息，来自重症监护临床医生的小样本。然而，由于只有一半的受访者报告实施，因此需要采取额外的策略来推广明智选择建议，以对 ICU 环境中的护理产生有影响力的改变。
