Identifying low-value clinical practices in critical care medicine: protocol for a scoping review.
BACKGROUND
Reducing unnecessary, low-value clinical practice (ie, de-adoption) is key to improving value for money in healthcare, especially among patients admitted to intensive care units (ICUs) where resource consumption exceeds other medical and surgical populations. Research suggests that low-value clinical practices are common in medicine, however systematically and objectively identifying them is a widely cited barrier to de-adoption. We will conduct a scoping review to identify low-value clinical practices in adult critical care medicine that are candidates for de-adoption.


METHODS
We will systematically search the literature to identify all randomised controlled trials or systematic reviews that focus on diagnostic or therapeutic interventions in adult patients admitted to medical, surgical or specialty ICUs, and are published in 3 general medical journals with the highest impact factor (New England Journal of Medicine, The Lancet, Journal of the American Medical Association). 2 investigators will independently screen abstracts and full-text articles against inclusion criteria, and extract data from included citations. Included citations will be classified according to whether or not they represent a repeat examination of the given research question (ie, replication research), and whether the results are similar or contradictory to the original study. Studies with contradictory results will determine clinical practices that are candidates for de-adoption.


BACKGROUND
Our scoping review will use robust methodology to systematically identify a list of clinical practices in adult critical care medicine with evidence supporting their de-adoption. In addition to adding to advancing the study of de-adoption, this review may also serve as the launching point for clinicians and researchers in critical care to begin reducing the number of low-value clinical practices. Dissemination of these results to relevant stakeholders will include tailored presentations at local, national and international meetings, and publication of a manuscript. Ethical approval is not required for this study.
Departments of Critical Care Medicine and Community Health Sciences, The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Daniel J
DJ
Niven
Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
T Jared
TJ
McCormick
Department of Medicine, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Sharon E
SE
Straus
Departments of Medicine, and Community Health Sciences, The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Brenda R
BR
Hemmelgarn
Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Lianne P
LP
Jeffs
Departments of Critical Care Medicine, Medicine, and Community Health Sciences, The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Henry T
HT
Stelfox
D003422:Critical Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care; D012107:Research Design; D000098584:Scoping Reviews as Topic
STATISTICS & RESEARCH METHODS