From the Guidelines
To choose wisely in critical care medicine, healthcare providers should prioritize the top 5 list developed by the American Thoracic Society, American Association of Critical-Care Nurses, American College of Chest Physicians, and Society of Critical Care Medicine, as outlined in the Choosing Wisely Campaign 1. This approach is crucial in reducing the overuse of tests, treatments, and procedures that provide little to no benefit for patients, thereby improving the quality of care while combating the problem of high healthcare costs 1. The Choosing Wisely task force established explicit criteria for evaluating candidate items, generated lists of items, performed literature reviews on each, and sought external input from content experts to develop the top 5 list 1. Key considerations for choosing wisely include:
- Focusing on decisions that align with patient values and long-term goals
- Gathering relevant information from reliable sources to make informed decisions
- Balancing logical analysis with intuitive feelings
- Committing fully to decisions while remaining flexible enough to adjust course if circumstances change significantly
- Reviewing past decisions periodically to identify patterns and improve the decision-making process By adopting this approach, healthcare providers can ensure that their choices consistently move patients toward their authentic priorities, rather than being driven by external pressures or momentary impulses, ultimately leading to better patient outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Choosing Wisely Initiative
- The Choosing Wisely initiative aims to reduce the use of unnecessary, low-value medical services through the development of recommendations related to service utilization 2.
- The initiative promotes doctor-patient communication and reducing waste in healthcare, with the potential to make healthcare systems more efficient and beneficial to patients 3.
Effectiveness of Choosing Wisely Interventions
- Interventions by health systems to implement Choosing Wisely guidelines can reduce the use of low-value services, with multicomponent interventions targeting clinicians being the most effective type 4.
- Active interventions are more likely to generate intended results compared to the dissemination of Choosing Wisely recommendations only, with a success rate of 65% vs 13% 4.
- Interventions with multiple components are more successful than those with one component, with a success rate of 77% vs 47% 4.
Clinical Applications of Choosing Wisely
- The Choosing Wisely initiative has been applied in various clinical settings, including oncology, where it has been shown that there is room for improvement in concordance with recommendations 5.
- In nephrology, the initiative has identified areas for improvement in patient care and resource use, including the avoidance of nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or chronic kidney disease 2.
- The initiative has also been applied in the context of statin treatment, where it aims to individualize treatment and minimize side effects by considering efficacy and safety in specific clinical situations 6.