Choosing Wisely Canada climate-conscious recommendations for critical care medicine

The climate crisis represents the single largest threat to human health of the twenty-first century. The environmental footprint of providing critical care can be reduced if clinicians and administrators have guidance on how to do so safely. We sought to develop evidence-based recommendations to safely reduce the environmental footprint of critical care medicine.

A national Canadian multidisciplinary critical care medicine working group was convened to develop a list of climate-conscious recommendations for Choosing Wisely Canada. The working group developed and refined a list of recommendations between November 2023 and May 2024. Content experts and literature review informed the process. The working group used a three-stage structured anonymous voting process to select and refine the final list of recommendations.

The multidisciplinary working group consisted of 23 clinicians, educators, and trainees. A preliminary list of 28 recommendations was developed over the course of two working group meetings in early 2024. The final refined list of seven recommendations was finalized in May 2024. Recommendations include 1) avoiding unnecessary disposable glove use, 2) only changing ventilator tubing and circuits when visibly soiled, 3) avoiding stocking surplus supplies in patient rooms, 4) using oral/enteral medications over intravenous preparations when appropriate, 5) avoiding single-use equipment when re-usable options are available, 6) removing isolation precautions when deemed safe by infection control, and 7) de-prescribing unnecessary medications on transfer out of the intensive care unit.

This Special Article introduces seven Choosing Wisely Canada climate-conscious recommendations to empower clinicians in reducing the environmental impact of critical care medicine.