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Area of Science:

  • Health Services Research
  • Medical Practice Improvement
  • Evidence-Based Medicine

Background:

  • Clinical practice should align with current evidence.
  • Tradition-based practices lacking evidence should be discontinued.
  • The Choosing Wisely campaign highlights practices needing re-evaluation.

Purpose of the Study:

  • To explore the process of de-implementation.
  • To identify barriers and facilitators to de-implementing tradition-based practices.
  • To examine critical care exemplars of de-implementation.

Main Methods:

  • Literature review on de-implementation.
  • Analysis of barriers and facilitators.
  • Case study examination of three critical care practices.

Main Results:

  • De-implementation faces significant barriers, including cognitive dissonance and psychological bias.
  • Stakeholder engagement is critical for successful de-implementation.
  • Facilitators include strong evidence and clear guidelines.

Conclusions:

  • Understanding and addressing de-implementation challenges is essential for advancing evidence-based practice.
  • Overcoming resistance to change is key to improving patient care.
  • De-implementation requires a multi-faceted approach involving all stakeholders.