De-implementing low value care in critically ill patients: a call for action—less is more

Excerpt

“More care is not always better [1].” As clinicians we are tasked with caring for patients while doing no harm. The pursuit of our mission has historically been driven by iteratively implementing new innovations designed to improve healthcare. Patients have benefited from this approach; however, an unintended consequence has been an increased number of clinical practices, some of which are low-value. A low-value practice is a practice for “which evidence suggests it confers no or very little benefit for patients, or the risk of harm exceeds probable benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits [2]”. The use of low-value practices compromises healthcare by increasing the complexity of care, exposing patients to unnecessary risks and adverse events, misallocating valuable resources, and potentially delaying treatment for other patients [3, 4]. These challenges are increasingly recognized in the care of critically ill patients whose management is often resource intensive. …