Department of Pediatrics, Seattle Children's Hospital, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.
Society of Critical Care Medicine, Mount Prospect, IL.
Crit Care Med. 2021 Mar 1;49(3):472-481. doi: 10.1097/CCM.0000000000004876.
To formulate new "Choosing Wisely" for Critical Care recommendations that identify best practices to avoid waste and promote value while providing critical care.
Semistructured narrative literature review and quantitative survey assessments.
English language publications that examined critical care practices in relation to reducing cost or waste.
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.
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.
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.
制定新的《明智选择》重症监护建议，以确定最佳实践，避免浪费，同时提供重症监护。
半结构化叙述性文献回顾和定量调查评估。
英文出版物，研究与降低成本或浪费有关的重症监护实践。
评估为重症监护增加价值的实践分为几类。专家组评估、改良 Delphi 共识建设和定量调查分析确定了八项避免浪费重症监护实践的新建议。这些建议提交给重症监护医学学会会员进行评估和排名。
重症监护医学学会会员定量调查的结果确定了八项建议中的前五项。这五个最高排名的建议确立了重症监护医学学会的下一个五项“明智选择”的重症监护实践。
五项新的减少重症监护实践中的浪费和提高价值的建议涉及侵入性器械、积极从机械通气中解放、抗生素管理、早期动员和提供目标一致的护理。这些建议补充了《明智选择》活动的最初重症监护建议。
