title: An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine.
abstract: BACKGROUND
  The high costs of health care in the United States and other developed nations are attributable, in part, to overuse of tests, treatments, and procedures that provide little to no benefit for patients. To improve the quality of care while also combating this problem of cost, the American Board of Internal Medicine Foundation developed the Choosing Wisely Campaign, tasking professional societies to develop lists of the top five medical services that patients and physicians should question.
  
  
  OBJECTIVE
  To present the Critical Care Societies Collaborative's Top 5 list in Critical Care Medicine and describe its development.
  
  
  METHODS
  Each professional society in the Collaborative nominated members to the Choosing Wisely task force, which established explicit criteria for evaluating candidate items, generated lists of items, performed literature reviews on each, and sought external input from content experts. Task force members narrowed the list to the Top 5 items using a standardized scoring system based on each item's likely overall impact and merits on the five explicit criteria.
  
  
  RESULTS
  From an initial list of 58 unique recommendations, the task force proposed a Top 5 list that was ultimately endorsed by each Society within the Collaborative. The five recommendations are: (1) do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions; (2) do not transfuse red blood cells in hemodynamically stable, nonbleeding ICU patients with an Hb concentration greater than 7 g/dl; (3) do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay; (4) do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation; and (5) do not continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.
  
  
  CONCLUSIONS
  These five recommendations provide a starting point for clinicians and patients to make decisions leading to higher-quality, lower-cost care. Future work is needed to promote adherence to these recommendations and to develop additional ways for intensive care clinicians to take leadership in reining in health-care costs.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.forename: Deborah
authors.initials: D
authors.lastname: Becker
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Robert
authors.initials: R
authors.lastname: Hyzy
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Nishi
authors.initials: N
authors.lastname: Rawat
authors.forename: Curtis N
authors.initials: CN
authors.lastname: Sessler
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
mesh_terms: D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D003422:Critical Care / Q000191:economics / Q000379:methods* / Q000592:standards*; D016638:Critical Illness / Q000191:economics; D054810:Deep Sedation / Q000191:economics / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008020:Life Support Care / Q000191:economics / Q000706:statistics & numerical data*; D010288:Parenteral Nutrition / Q000191:economics / Q000706:statistics & numerical data*; D010820:Physicians; D012955:Societies, Medical; D014481:United States
keywords: Choosing Wisely; cost effectiveness; critical care; quality improvement