Abstract:
OBJECTIVES:Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation's Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess how critical care clinicians were implementing the Critical Care Societies Collaborative Choosing Wisely recommendations in clinical practice. DESIGN:Descriptive survey methodology with use of Research Electronic Data Capture (https://projectredcap.org/) sent via email newsletter blast or to individual emails of the 150,000 total members of the organizations. SETTING:National survey. SUBJECTS:ICU physicians, nurses, advanced practice providers including nurse practitioners and physician assistants, and pharmacist members of four national critical care societies in the United States. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:A six-question survey assessed what Choosing Wisely recommendations had been implemented in ICU settings and if the impact was assessed. A total of 2,520 responses were received from clinicians: nurses (61%; n = 1538), physicians (25.9%; n = 647), advanced practice providers (10.5%; n = 263), and pharmacists (2.1%; n = 52), reflecting a 1.6% response rate of the total membership of 150,000 clinicians. Overall, 1,273 respondents (50.6%) reported they were familiar with the Choosing Wisely campaign. Respondents reported that Choosing Wisely recommendations had been integrated in a number of ways including being implemented in clinical care (n = 817; 72.9%), through development of a specific clinical protocol or institutional guideline (n = 736; 65.7%), through development of electronic medical record orders (n = 626; 55.8%), or with integration of longitudinal tracking using an electronic dashboard (n = 213; 19.0%). Some respondents identified that a specific quality improvement initiative was developed related to the Choosing Wisely recommendations (n = 468; 41.7%), or that a research initiative had been conducted (n = 156; 13.9%). CONCLUSIONS:The results provide information on the application of the Choosing Wisely recommendations to clinical practice from a small sample of critical care clinicians. However, as only half of the respondents report implementation, additional strategies are needed to promote the Choosing Wisely recommendations to make impactful change to improve care in ICU settings.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Kleinpell R,Sessler CN,Wiencek C,Moss Mdoi
10.1097/CCM.0000000000003496subject
Has Abstractpub_date
2019-03-01 00:00:00pages
331-336issue
3eissn
0090-3493issn
1530-0293pii
00003246-201903000-00004journal_volume
47pub_type
杂志文章abstract::We previously reported that small volume infusions of 7.5% NaCl in 6% dextran-70 (HSD) are superior to equal volumes of normal saline (NS) or 7.5% NaCl in the ability to resuscitate animals from an otherwise lethal hemorrhage. In the present experiment, we evaluated organ blood flow in unanesthetized swine bled 46 ml/...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00009
更新日期:1987-12-01 00:00:00
abstract::Pulmonary barotrauma developed in 18/430 patients receiving respirator support for longer than 12 hours. Pneumothorax occurred in 15 of these patients and was treated with tube thoracostomy and 15-20 cm H2O pleural suction. Full reexpansion of the lungs were achieved in all but three patients, two of whom had bronchop...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197503000-00004
更新日期:1975-03-01 00:00:00
abstract:OBJECTIVE:In the pathogenesis of disseminated intravascular coagulation, dysfunctional natural anticoagulant pathways appear to play a pivotal role. In this article, we will address the mechanisms that contribute to this defect in the regulation of coagulation activation. Furthermore, we will explore the experimental a...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200107001-00028
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:To assess the intrarater and interrater reliability of electrocardiogram (ECG) interpretation in critically ill patients and to assess the effect of knowledge of cardiac troponin values on these reliability estimates. DESIGN:Prospective cohort study. SETTING:Fifteen-bed medical-surgical intensive care unit....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000214679.23957.90
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:Cerebral perfusion pressure<40 mm Hg following pediatric traumatic brain injury has been associated with increased mortality independent of age, and current guidelines recommend maintaining cerebral perfusion pressure between 40 mm Hg-60 mm Hg. Although adult traumatic brain injury studies have observed an in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31825333e6
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To document the effects of propofol on the hemodynamic and inflammatory responses to endotoxemia in an animal model. DESIGN:Randomized, prospective laboratory study. SETTING:University experimental laboratory. SUBJECTS:Thirty-two male rats. INTERVENTIONS:The animals were randomly assigned to one of four g...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200004000-00032
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND AND METHODS:We postulated that low-dose heparin (10 IU/kg.hr) administered as a continuous iv infusion may prevent or ameliorate the induction of thrombin-induced disseminated intravascular coagulation in baboons under general anesthesia. In a nonrandomized experiment lasting 8 hrs, animals were divided into...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00017
更新日期:1991-09-01 00:00:00
abstract::With the thermodilution technique, repeated determination of cardiac index (CI) has become a rapid, easily accomplished, safe procedure. We paired 77 CI determinations measured by direct Fick and thermodilution techniques in 21 patients who underwent myocardial revascularization. Commercially available thermistor-tipp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197509000-00002
更新日期:1975-09-01 00:00:00
abstract:OBJECTIVES:To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN:Quasi-experimental, before-after trial. SETTING:Emergency department and ICUs of an academic cente...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002268
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To assess the effect of high-dose N-acetylcysteine on renal function in cardiac surgery patients at higher risk of postoperative renal failure. DESIGN:Multiblind, placebo-controlled, randomized, phase II clinical trial. SETTING:Operating rooms and intensive care units of two tertiary referral hospitals. PA...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.CCM.0000261887.69976.12
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:To examine variations in case-mix, structure, resource use, and outcome performance among teaching and nonteaching intensive care units (ICU). DESIGN:Prospective inception cohort study. PATIENTS:A consecutive sample of 15,297 patients at 35 hospitals, which compared 8,269 patients admitted to 20 teaching IC...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199310000-00009
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the accuracies of the respiratory rate/tidal volume ratio (rate/volume ratio), minute volume, and negative inspired force in predicting weaning outcome in postoperative mechanically ventilated patients. DESIGN:A prospective, observational study. SETTING:Surgical intensive care unit of a 270-bed ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199702000-00010
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVE:Acute respiratory distress syndrome is occasionally seen in newborn infants due to a severe inflammatory process in the lungs that affects capillary-alveolar permeability, epithelial integrity, and type I and II pneumocyte function. The aim of this study was to investigate the effect of a topically applied nu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000166371.18066.5e
更新日期:2005-06-01 00:00:00
abstract:OBJECTIVE:The emergency department (ED) often serves as the first site for the recognition and treatment of patients with suspected severe sepsis. However, few evaluations of the national epidemiology and distribution of severe sepsis in the ED exist. We sought to determine national estimates of the number, timing, ED ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000277043.85378.C1
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:Preoperative intra-aortic balloon pumping (IABP) improves the results of complex coronary surgery. However, its insertion may be harmful or contraindicated in cases of severe and diffuse atherosclerosis of the descending aorta and peripheral arteries. We sought to evaluate the efficacy and safety of transbrac...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000229884.94475.DB
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:Antimicrobial effects of nitric oxide (NO) have been demonstrated in vitro against a variety of infectious pathogens, yet in vivo evidence of a potential therapeutic role for exogenous NO as an antimicrobial agent is limited. Thus, we assessed the effects of inhaled NO on pulmonary infection, leukocyte infilt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00035
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To present electron micrographs of lung tissue obtained from a patient exposed to high ventilatory pressures in the context of pulmonary dysfunction and pulmonary hypertension. DESIGN:Case report. SETTING:Adult intensive care unit of a university-affiliated teaching hospital. PATIENTS:A patient exposed to ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200210000-00030
更新日期:2002-10-01 00:00:00
abstract::Patients (n = 158) who had been respirator-treated and who could remember the treatment were retrospectively (after greater than 2 months) interviewed about their experiences. Of all patients, 47% had felt anxiety and/or fear during the treatment. These feelings were intimately related to the experience of agony/panic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198910000-00021
更新日期:1989-10-01 00:00:00
abstract::The authors determined the correction factor (Ct) for three sizes of commonly available central venous catheters. These catheters are used as the injectate catheter when a 2.5 Fr transthoracic thermistor is used to determine cardiac output by thermodilution. The valves for Ct were highly reproducible. These determinat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198112000-00014
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. OBJECTIVE:To describe the time course of the platelet count in relation to the mortality rate ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200204000-00005
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVES:Mild decrease in core temperature (therapeutic hypothermia) provides lasting neuroprotection following cardiac arrest or cerebral ischemia. However, current methods for producing therapeutic hypothermia trigger a cold-defense response that must be countered by sedatives, muscle paralytics, and mechanical ven...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000229
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To test the reliability and validity of a modified moral distress tool, originally developed for the nursing profession, on respiratory care practitioners. To describe the relationship between moral distress, career dissatisfaction, and job turnover in respiratory care. DESIGN:A 28-question survey was develo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000248879.19054.73
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the cardiopulmonary effects of the novel endothelin receptor antagonist tezosentan in endotoxin-induced lung injury in sheep and to assess the dose response to tezosentan and endothelin-1 in healthy sheep. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University animal l...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000114575.08269.f6
更新日期:2004-03-01 00:00:00
abstract::Severe complications sometimes occur in critically ill patients during intrahospital transport. Possible causes may be inadequate ventilation, insufficient monitoring, interrupted application of vasoactive drugs, or disconnections and accidental extubation. We constructed a transport unit equipped with a respirator; c...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199012000-00024
更新日期:1990-12-01 00:00:00
abstract:OBJECTIVES:Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. DESIGN:A...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31828a4337
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:Mannitol is widely used in hospitals worldwide to treat patients with high intracranial pressure and/or cerebral edema. One of the mechanisms by which mannitol is thought to affect intracranial pressure is by increasing the patient's serum osmolarity, but not the osmolarity in the brain or cerebrospinal fluid...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000050287.68977.84
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVES:Previous studies in adults suggest that various types of physiologic stress appear to decrease phagocytic cell function. Adherence and chemotaxis of, and phagocytosis and bacterial killing by, neonatal neutrophils are altered compared with adult neutrophil function. Stresses encountered by the fetus and neon...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199312000-00022
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVES:Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00009
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the possible effects of a combination of systemic nitric oxide synthesis inhibition (to increase mean arterial blood pressure) and nitric oxide inhalation (to decrease pulmonary vascular pressure) in porcine endotoxin shock. DESIGN:Prospective trial. SETTING:Laboratory at a large university medi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199505000-00020
更新日期:1995-05-01 00:00:00