Choosing Wisely - Top 7 List in Critical Care Medicine

This morning, at the ATS conference in Philadelphia, Scott Halpern, MD, PhD, MBE, presented "Top Ways to Reduce Low Value Care in Pulmonary and Critical Care Medicine."  Halpern leads the ATS's Choosing Wisely Task Force. 



"Choosing Wisely is designed to have physicians take the high ground in reining in the costs of their practices versus leaving that in the hands of external policymakers. . . .  There are a lot of diagnostic tests and therapies for which available evidence suggests a lack of effectiveness, and physicians are in the best position to determine exactly which practices in their own specialties fit that bill." 



Choosing Wisely Top 7 List in Critical Care Medicine:

1. Don't order diagnostic tests at regular intervals (e.g., daily), but rather in response to specific clinical questions.


2. Don't transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dL.


3. Don't use parenteral nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay.


4. Don't deeply sedate mechanically ventilated patients without specific indications, and do attempt to lighten sedation daily.


5. Don't continue life support for patients at high risk for death or impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.


6. Do not initiate or continue antimicrobial agents without specifying an evidence-based duration or endpoint and reassessing daily whether to narrow the spectrum of coverage based on cultures and clinical response.


7. Do not place or maintain arterial and central venous catheters in critically ill patients without specific indications.