Choosing Wisely for quality improvement: more is not always better

It is not an entirely original observation that critical care medicine can be divided into two eras: a ‘maximalist’ era and a ‘minimalist’ era. From its founding as a specialty in 1952, critical care practice and research focused on increasingly invasive interventions to support patients’ failing organs. The reflex response to a problem was generally a new intervention. However, since the early 2000s, there is a growing weight of evidence suggesting that excessive and burdensome interventions are not good for patients (or staff). High volume ventilation,1 unsuitably invasive haemodynamic monitoring,2 excessively aggressive filtration3 and liberal sedation4 5 are all associated with—at best—no benefit and—at worst—poorer outcomes. The international Choosing Wisely campaign champions avoiding wasteful, or even potentially harmful, interventions. The multiple discipline-specific campaigns help clinicians pare back or de-implement interventions that are considered low-value care—those for which there is...

Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Stephens, T. J., Thomson, W. R. Tags: Editorials Source Type: research