Sunday, December 07, 2014

Critical care choosing wisely list

The critical care list was a collaborative effort by 4 professional societies. The list is linked here at Intensive Care Medicine-Working Knowledge. It's a great list with the exception of item 1 which makes no sense to me:

1. Do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions;

My specific clinical question every morning is “how are the patient's chemistries today?” but that's not what the writers had in mind. If you're going to wait for a “clinical” (non-laboratory) question to trigger ordering labs what would that be? Do you wait for the patient to get confused or start having arrhythmias before ordering chemistries?

Hospital medicine had a similar recommendation but it said to stop ordering daily labs on stable patients. I can't argue with that wording but by the time patients are stabilized they're ready for discharge.

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