Deadoption of low-value practices in the ICU

Area of Science:

• Critical Care Medicine
• Health Services Research
• Medical Practice Management

Background:

• Low-value practices, defined as medical interventions providing little to no patient benefit and potentially causing harm, are prevalent across healthcare.
• While some low-value practices have been successfully removed from intensive care units (ICUs), many persist, posing challenges to effective patient care.
• The process of removing established medical practices is termed deadoption, with varying success rates depending on the practice's characteristics.

Purpose of the Study:

• To review the challenges associated with the discontinuation of ineffective or harmful practices in the ICU.
• To outline current strategies and thinking regarding the deadoption of low-value practices within critical care settings.
• To advocate for a comprehensive approach to removing outdated or non-beneficial medical interventions from routine ICU care.

Main Methods:

• This review synthesizes current literature and expert opinion on the deadoption of low-value practices in ICUs.
• It examines the factors contributing to the persistence of ineffective treatments and explores successful deadoption strategies.
• The review emphasizes a multimodal approach, integrating various interventions to facilitate practice change.

Main Results:

• Deadoption of practices that cause harm or are disproportionately costly relative to their benefit remains a significant challenge in ICUs.
• Low-value practices that are merely ineffective, with minimal harm or cost, present particular difficulties for removal.
• No single intervention has proven universally effective; a combination of strategies is necessary for successful deadoption.

Conclusions:

• Effective deadoption requires tailoring strategies to local ICU circumstances while considering the broader healthcare spectrum.
• Engaging nursing staff and utilizing local champions, particularly peers, are crucial for driving practice change.
• Sustainability of deadoption efforts necessitates ongoing support and recognition of the need for continuous improvement in critical care.