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Choosing Wisely in Critical Care

Results of a National Survey From the Critical Care Societies Collaborative*

Kleinpell, Ruth, PhD, RN, ACNP, FCCM1,2; Sessler, Curtis N., MD, FCCP, FCCM3,4; Wiencek, Clareen, PhD, RN, ACNP, ACHPN5,6; Moss, Marc, MD7,8

doi: 10.1097/CCM.0000000000003496
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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 ( 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.

1Vanderbilt University School of Nursing, Nashville, TN.

2Society of Critical Care Medicine, Mt. Prospect, IL.

3Virginia Commonwealth, Richmond, VA.

4American College of Chest Physicians, Glenview, IL.

5University of Virginia School of Nursing, Charlottesville, VA.

6American Association of Critical Care Nurses, Aliso Viejo, CA.

7University of Colorado Medical Center, Denver, CO.

8American Thoracic Society, New York, NY.

*See also p. 469.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Ruth Kleinpell, PhD, RN, ACNP, FCCM, Vanderbilt University School of Nursing, 461 21st Avenue South, 226 GH Nashville, TN 37240. E-mail:

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