Survey offers insight into strategies to reduce unnecessary tests, treatments in critical care settings

Research published in American Journal of Critical Care finds less than 40% of nurse respondents were aware of the ICU-specific Choosing Wisely recommendations


Newswise — A national survey of acute and critical care nurses finds that measures to reduce unnecessary testing and treatments are increasingly being integrated into clinical practice, even though most respondents are not aware of the campaign behind the specific recommendations. 

A multidisciplinary Critical Care Societies Collaborative (CCSC) work group conducted the survey to assess awareness and use of five ICU-specific recommendations that CCSC developed as part of the Choosing Wisely initiative. The results, “Choosing Wisely in Critical Care: A National Survey of Critical Care Nurses,” are published in the November issue of American Journal of Critical Care (AJCC).

The ABIM Foundation established the Choosing Wisely initiative in 2012, encouraging professional medical societies to develop lists of medical tests, treatments and procedures that are commonly used but whose necessity should be questioned.

CCSC responded by developing a list of five ICU-specific recommendations and encouraging individual CCSC members to incorporate them into practice. The CCSC is a partnership among the four main associations whose members care for critically ill patients in the United States. Its members are the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians, the American Thoracic Society and the Society of Critical Care Medicine.

As part of CCSC’s work with Choosing Wisely, AACN became the first nursing organization to actively contribute to the development of a list of recommendations.

Co-author Clareen Wiencek, PhD, RN, ACNP, is an AACN past president and associate professor of nursing and director of advanced practice, University of Virginia School of Nursing, Charlottesville. She represented AACN on the CCSC workgroup.

“The Choosing Wisely critical care list was the first developed in partnership with a nursing professional society (AACN), which is important and noteworthy because it reflects the multi-professional nature of critical care,” she said. “Because nurses consistently oversee patient care at the bedside, they can play a significant role in ensuring that organizations and individual units are aware of, and work to implement, the Choosing Wisely critical care recommendations.”

The workgroup added six questions specific to Choosing Wisely to a national survey of all 150,000+ members of the CCSC organizations. A total of 1,651 responses were received from nurses who reported membership in AACN, including 200 respondents who identified themselves as advanced practice nurses (APRNs).

Overall, less than 40% reported being familiar with the Choosing Wisely campaign, with more APRNs (64%) than registered nurses (36%) reporting awareness of CCSC’s critical care recommendations.

In addition, about 38% reported that the CCSC recommendations had been implemented in their practice settings, to varying degrees and in different ways:

  • Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. (50.2%)
  • Don’t transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL. (85.5%)
  • Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an intensive care unit. (47.3%)
  • Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. (80.5%)
  • Don’t 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. (67.1%)

The work group also used the open-ended comment section to identify recurring themes and specific strategies to raise awareness and address barriers to implementation. 

The list, including more detailed explanations and supporting references, is online at ChoosingWisely.org. A downloadable PDF, suitable for use in staff meetings and posting, is also available.

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 120,000 acute and critical care nurses and can be accessed at www.ajcconline.org.

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109;

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