Wise Choices in the Intensive Care Unit

Summary

Aim: to evaluate if the Choosing Wisely campaign can be introduced without harming critically ill patients.

Background: Each year, around 45,000 patients are admitted to Sweden's 81 ICUs (intensive care units), costing 6-7 billion SEK (6% of total healthcare expenditure). The high costs of health care are partly attributable to overuse of diagnostic tests. Up to 30% of these tests lead to treatments that provide no benefit for patients, some of them may even be harmful(1-3). To improve quality of care while combating this problem of cost, the American Board of Internal Medicine Foundation developed the Choosing Wisely Campaign, tasking professional societies to develop lists of top five medical services patients and physicians should question. Patients in the ICU, can especially benefit from this paradigm shift. They are subjected to multiple testing on a daily - sometimes hourly - basis, therefore this field of medicine responded to the campaign quickly. Two sets of top-five-lists of tests and interventions that can be questioned have been published(4 5).

In multiple countries, including Sweden, the Choosing Wisely campaign is gathering traction among critical care physicians and is on the verge of being introduced. It is both common-sensical and will save money, so health care leaders are positive. However, the investigators have an opportunity, and a duty, to assess the evidence; can the Choosing Wisely campaign be introduced without harming ICU patients?

The present study thus aims to evaluate the introduction of the Choosing Wisely campaign in the context of the ICU. Is this change of care strategy associated with changes in 30-day-mortality? Secondary outcomes include ICU length of stay, use of non-invasive- or invasive mechanical ventilation and continuous renal replacement therapy. This is a registry-based cluster randomized controlled study (R-RCT), targeting Swedish ICU's across multiple regions. Primary and secondary outcomes will be retrieved from the Swedish Intensive care Register (SIR), making ICU participation easier and less costly.

Conditions

• Dialysis
• Critical Illness
• Ventilation
• Outcome
• Acute Kidney Injury

Interventions

PROCEDURE

Choosing wisely protocol

Se arm description

Sponsors & Collaborators

• Uppsala-Örebro Regional Research Council

  collaborator OTHER

• Vastra Gotaland Region

  collaborator OTHER_GOV

• Region Jönköping County

  collaborator OTHER_GOV

• Region Skane

  collaborator OTHER

• Region Stockholm

  collaborator OTHER_GOV

• Sormland County Council, Sweden

  collaborator OTHER

• Karolinska Institutet

  lead OTHER

Principal Investigators

• Max B Bell, MD, PhD · N32276 PMI/Karolinska

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-11-03

Primary Completion

2026-12-31

Completion

2027-12-31

Countries

• Sweden

Study Locations