Low-value clinical practices in injury care: A scoping review and expert consultation survey
| Autor: | Jerome Paquet, Henry T. Stelfox, Eric Mercier, Imen Farhat, François Lauzier, Howard R. Champion, Alexis F. Turgeon, Francois Lamontagne, Peter Cameron, Pier-Alexandre Tardif, Patrick Archambault, Michael Chassé, Fiona Lecky, Simon Berthelot, Catherine Truchon, Belinda J. Gabbe, Paule Lessard Bonaventure, Lynne Moore, Natalie L. Yanchar, Khadidja Malloum Boukar, John B. Kortbeek |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Quality management Critical Care Attitude of Health Personnel Psychological intervention MEDLINE Critical Care and Intensive Care Medicine Likert scale 03 medical and health sciences Patient safety 0302 clinical medicine Health care Humans Medicine Practice Patterns Physicians' business.industry 030208 emergency & critical care medicine Evidence-based medicine Quality Improvement Family medicine Wounds and Injuries Surgery Patient Safety business Trauma surgery |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 86:983-993 |
| ISSN: | 2163-0763 2163-0755 |
| Popis: | BACKGROUND: Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of healthcare resources. Choosing Wisely and other organisations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS: We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a 5-point Likert scale from clearly low-value to clearly beneficial. Clinical practices reported as low-value by at least one level I, II or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS: Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit and 5 in orthopaedics. We also identified 87 'grey zone' practices, which did not meet our criteria for low-value care. CONCLUSIONS: We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 'grey zone' practices, which may be interesting targets for value-based decision-making. Our study represents an important step towards the de-implementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE: III. |
| Databáze: | OpenAIRE |
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