De-implementing low value care in critically ill patients: a call for action—less is more
- 528 Downloads
“More care is not always better .” As clinicians we are tasked with caring for patients while doing no harm. The pursuit of our mission has historically been driven by iteratively implementing new innovations designed to improve healthcare. Patients have benefited from this approach; however, an unintended consequence has been an increased number of clinical practices, some of which are low-value. A low-value practice is a practice for “which evidence suggests it confers no or very little benefit for patients, or the risk of harm exceeds probable benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits ”. The use of low-value practices compromises healthcare by increasing the complexity of care, exposing patients to unnecessary risks and adverse events, misallocating valuable resources, and potentially delaying treatment for other patients [3, 4]. These challenges are increasingly recognized in the care of critically ill patients...
KeywordsDe-implementation Intensive care units Critical care Information science Health services research Quality of health care
- 7.Helfrich CD, Rose AJ, Hartmann CW, van Bodegom-Vos L, Graham ID, Wood SJ, Majerczyk BR, Good CB, Pogach LM, Ball SL, Au DH, Aron DC (2018) How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: a preliminary model of unlearning and substitution. J Eval Clin Pract 24:198–205CrossRefGoogle Scholar
- 16.Stelfox HT, Brundin-Mather R, Soo A, Parsons Leigh J, Niven DJ, Fiest KM, Doig CJ, Zuege DJ, Kushner B, Clement F, Straus SE, Cook DJ, Bagshaw SM, Sauro KM (2019) A multicentre controlled pre-post trial of an implementation science intervention to improve venous thromboembolism prophylaxis in critically ill patients. Intensive Care Med 45:211–222CrossRefGoogle Scholar
- 22.Menegueti MG, Ciol MA, Bellissimo-Rodrigues F, Auxiliadora-Martins M, Gaspar GG, Canini S, Basile-Filho A, Laus AM (2019) Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine (Baltimore) 98:e14417CrossRefGoogle Scholar