Overuse of laboratory and X-ray testing is common in the intensive care unit (ICU). This review highlights focused strategies for critical care clinicians as outlined by the Critical Care Societies Collaborative (CCSC) as part of the American Board of Internal Medicine Foundation’s Choosing Wisely® campaign. The campaign aims to promote the use of judicious testing and decrease unnecessary treatment measures in the ICU. The CCSC outlines five specific recommendations for reducing unnecessary testing in the ICU. First, reduce the use of daily or regular interval diagnostic testing. Second, do not transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dl. Third, do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of ICU stay. Fourth, do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. Finally, do not continue life support for patients at high risk of death without offering patients and their families the alternative of comfort focused care. A number of strategies can be used to reduce unnecessary testing in the ICU, including educational campaigns, audit and feedback, and implementing prompts in the electronic ordering system to allow only acceptable indications when ordering routine testing. Greater awareness of the lack of outcome benefit and associated costs can prompt clinicians to be more mindful of ordering tests and procedures in order to reduce unnecessary testing in the ICU.
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Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review Luigi Devis, Emilie Catry, Patrick M. Honore, Alexandre Mansour, Giuseppe Lippi, François Mullier, Mélanie Closset Annals of Intensive Care.2024;[Epub] CrossRef
Blood gas sampling in the intensive care unit: A prospective before-and-after interventional study on the effect of an educational program on blood gas testing frequency Benjamin Cunanan, Haindavi Muppa, Liliana Orellana, Samantha Bates, Forbes McGain Australian Critical Care.2024;[Epub] CrossRef
Cost analysis of hospitals performing continuous albuterol in non-intensive care settings Adjoa A. Andoh,, Charmaine B. Lo,, Junxin Shi,, Ryan S. Bode,, Samantha W. Gee,, Julie C. Leonard, Journal of Asthma.2023; 60(2): 314. CrossRef
What blood conservation practices are effective at reducing blood sampling volumes and other clinical sequelae in intensive care? A systematic review Samantha Keogh, Saira Mathew, Amanda J. Ullman, Claire M. Rickard, Fiona Coyer Australian Critical Care.2023; 36(6): 1129. CrossRef
Towards net zero: critical care Heather Baid, Eleanor Damm, Louise Trent, Forbes McGain BMJ.2023; : e069044. CrossRef
Effect of a Performance Feedback Dashboard on Hospitalist Laboratory Test Utilization Caroline McCormick, Sarvpreet Ahluwalia, Ankur Segon American Journal of Medical Quality.2023; 38(6): 273. CrossRef
Availability of Multiple Organ Failure Score Components in Surgical Patients Maxwell C. Braasch, Bachar N. Halimeh, Christopher A. Guidry Surgical Infections.2022; 23(2): 178. CrossRef
Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study Tine François, Michaël Sauthier, Julien Charlier, Jessica Dessureault, Marisa Tucci, Karen Harrington, Laurence Ducharme-Crevier, Sally Al Omar, Jacques Lacroix, Geneviève Du Pont-Thibodeau Pediatric Critical Care Medicine.2022; 23(6): 435. CrossRef
Predicting Abnormal Laboratory Blood Test Results in the Intensive Care Unit Using Novel Features Based on Information Theory and Historical Conditional Probability: Observational Study Camilo E Valderrama, Daniel J Niven, Henry T Stelfox, Joon Lee JMIR Medical Informatics.2022; 10(6): e35250. CrossRef
Implementation and Impact of Choosing Wisely Recommendations in Oncology Sonieya Nagarajah, Melanie Lynn Powis, Rouhi Fazelzad, Monika K. Krzyzanowska, Vishal Kukreti JCO Oncology Practice.2022; 18(10): 703. CrossRef
Blood loss from laboratory testing, anemia, and red blood cell transfusion in the intensive care unit: a retrospective study Nicholas L. Jackson Chornenki, Tyler E. James, Rebecca Barty, Yang Liu, Bram Rochwerg, Nancy M. Heddle, Deborah M. Siegal Transfusion.2020; 60(2): 256. CrossRef
Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review Madison Foster, Justin Presseau, Nicola McCleary, Kelly Carroll, Lauralyn McIntyre, Brian Hutton, Jamie Brehaut Implementation Science.2020;[Epub] CrossRef
Labordiagnostik in der Intensivmedizin S. Petros, L. Weidhase Medizinische Klinik - Intensivmedizin und Notfallmedizin.2020; 115(7): 539. CrossRef
Labordiagnostik in der Intensivmedizin Sirak Petros, Lorenz Weidhase Wiener klinisches Magazin.2020; 23(6): 298. CrossRef