收稿日期: 2024-02-29
网络出版日期: 2025-01-14
基金资助
甘肃省科学技术厅科技计划项目（基础研究计划）(23JRZA483);甘肃省卫生健康行业科研项目(GSWSHL2022-22)
Research progress in the field of de-implementation of low-value care in the field of critical care
低价值护理（low-value care，LVC）“去实施化”指通过移除、替换、减少或限制等方式摒弃无效或低效的护理服务。ICU患者病情危重，因此实施高效安全的治疗和护理尤为重要。LVC“去实施化”有利于促进ICU护理管理和质量改进，节约经济成本和减轻工作负担。该研究通过综述LVC“去实施化”科学的概念、危重症领域的“明智选择”运动及相关研究、ICU变革策略及对LVC“去实施化”的思考等，旨在为中国ICU质量改进和护理管理提供参考，未来应在制订符合中国ICU低价值服务清单及研发评估ICU低价值服务的决策工具等方面做进一步研究。
宋亚奇 , 钟娟平 , 程斐然 , 任李媛 , 左倩倩 , 魏政勇 , 豆欣蔓 . 低价值护理“去实施化”在危重症领域的研究进展[J]. 中华急危重症护理杂志, 2025 , 6(1) : 65 -69 . DOI: 10.3761/j.issn.2096-7446.2025.01.009
The de-implementation of low-value care（LVC） refers to the elimination of ineffective or inefficient care services by removing，replacing，reducing，or limiting. ICU patients are critically ill，so it is important to implement efficient and safe treatment and care. The de-implementation of LVC is conducive to promoting ICU management and quality improvement，saving economic costs and reducing work burden. This article aims to provide a reference for ICU quality improvement and nursing management in China by reviewing the concept of LVC de-implementation science，the “Choosing Wisely” in the field of critical care and related research，the ICU reform strategy，and the thinking on LVC de-implementation.In the future，further research should be conducted in formulating a list of LVC services in ICUs suitable for China and developing decision-making tools for evaluating LVC services in ICUs.
| [1] | Patey AM, Soong C. Top-down and bottom-up approaches to low-value care[J]. BMJ Qual Saf, 2023, 32(2):65-68. |
| [2] | 关瑜山, 伍思涵, 李杰红, 等. 基于我国临床护理实践指南的护理低价值项目清单构建[J]. 护理学杂志, 2023, 38(4):66-71. |
| Guan YS, Wu SH, Li JH, et al. Development of list of low-value care services based on chinese nursing clinical practice guidelines[J]. J Nurs Sci, 2023, 38(4):66-71. | |
| [3] | Parsons Leigh J, Petersen J, de Grood C, et al., Mapping struc-ture,process and outcomes in the removal of low-value care practices in Canadian intensive care units:protocol for a mixed-methods exploratory study[J]. BMJ Open, 2019, 9(12):e033333. |
| [4] | 李加敏, 李学靖, 张小艳, 等. “去实施”的概念分析及研究现状[J]. 中华护理杂志, 2023, 58(17):2171-2176. |
| Li JM, Li XJ, Zhang XY, et al. Concept analysis and research progress of de-implementation[J]. Chin J Nurs, 2023, 58(17):2171-2176. | |
| [5] | Kleinpell R, Sessler CN, Wiencek C, et al. Choosing wisely in critical care:results of a national survey from the critical care societies collaborative[J]. Crit Care Med, 2019, 47(3):331-336. |
| [6] | Tume LN, Aitken LM. De-implementation of low value clinical practices is essential for critical care nurses[J]. Nurs Crit Care, 2024, 29(2):244-245. |
| [7] | Jenkins B, Calder PC, Marino LV. Gastric residual volume mo-nitoring practices in UK intensive care units:A web-based survey[J]. J Intensive Care Soc, 2024, 25(2):156-163. |
| [8] | 重症患者早期肠内营养临床实践专家共识[J]. 中华危重病急救医学, 2018, 30(8):715-721. |
| Consensus of early enteral nutrition clinical practice in criti-cally ill patients[J]. Chin Crit Care Med, 2018, 30(8):715-721. | |
| [9] | 刘雨安, 张玉霞, 樊晓辉, 等. “明智选择”运动发展现状及对我国ICU临床护理的启示[J]. 护理研究, 2021, 35(6):1052-1055. |
| Liu YA, Zhang YX, Fan XH, et al. Development status quo of “choosing wisely” movement and its enlightenment to ICU clinical nursing in China[J]. Chin Nurs Res, 2021, 35(6):1052-1055. | |
| [10] | 刘纬华, 杨琳, 周海宁, 等. 低价值护理去实施化的研究进展及启示[J]. 护士进修杂志, 2024, 39(1):26-31. |
| Liu WH, Yang L, Zhou HN, et al. Research progress and im-plications of de-implementation of low-value value[J]. J Nurses Train, 2024, 39(1):26-31. | |
| [11] | Trumbo SP, Iams WT, Limper HM, et al. Deimplementation of routine chest x-rays in adult intensive care units[J]. J Hosp Med, 2019, 14(2):83-89. |
| [12] | Conroy M, Homsy E, Johns J, et al. Reducing unnecessary labo-ratory utilization in the medical ICU:a fellow-driven quality improvement initiative[J]. Crit Care Explor, 2021, 3(7):e0499. |
| [13] | 李加敏, 李学靖, 杨丹, 等. 低价值护理的概念分析及研究现状[J]. 中华护理杂志, 2022, 57(17):2171-2176. |
| Li JM, Li XJ, Dan Y, et al. Concept analysis and research progress of low-value care[J]. Chin J Nurs, 2022, 57(17):2171-2176. | |
| [14] | Kerr EA, Kullgren JT, Saini SD. Choosing wisely:how to fulfill the promise in the next 5 years[J]. Health Aff(Millwood), 2017, 36(11):2012-2018. |
| [15] | Angus DC, Deutschman CS, Hall JB, et al. Choosing wisely((R)) in critical care:maximizing value in the intensive care unit[J]. Am J Crit Care, 2014, 23(6):444-446. |
| [16] | Zimmerman JJ, Harmon LA, Smithburger PL, et al. Choosing wisely for critical care:the next five[J]. Crit Care Med, 2021, 49(3):472-481. |
| [17] | Parker G, Kastner M, Born K, et al. Understanding low-value care and associated de-implementation processes:a qualitative study of Choosing Wisely Interventions across Canadian hospitals[J]. BMC Health Serv Res, 2022, 22(1):92. |
| [18] | Drury A, Muscat DM, Wibrow B, et al. Integrating the choosing wisely 5 questions into family meetings in the intensive care unit:a randomized controlled trial investigating the effect on family perceived involvement in decision-making[J]. J Patient Exp, 2022,9:23743735221092623. |
| [19] | Luk E, Burry L, Rezaie S, et al. Critical care nurses’ decisions regarding physical restraints in two Canadian ICUs:a pros-pective observational study[J]. Can J Crit Care Nurs, 2015, 26(4):16-22. |
| [20] | Soril LJJ, Noseworthy TW, Townsend DR, et al. Optimizing red blood cell transfusion practices in the intensive care unit:a multi-phased health technology reassessment[J]. Int J Technol Assess Health Care, 2021, 38(1):e10. |
| [21] | Morris ZS, Wooding S, Grant J. The answer is 17 years,what is the question:understanding time lags in translational research[J]. J R Soc Med, 2011, 104(12):510-520. |
| [22] | Wallace DJ. Strategies to effect change in the ICU[J]. Curr Opin Crit Care, 2019, 25(5):511-516. |
| [23] | Marra A, Ely EW, Pandharipande PP, et al. The ABCDEF bundle in critical care[J]. Crit Care Clin, 2017, 33(2):225-243. |
| [24] | Moraes FDS, Marengo LL, Moura MDG, et al. ABCDE and ABCDEF care bundles:a systematic review of the implemen-tation process in intensive care units[J]. Medicine (Baltimore), 2022, 101(25):e29499. |
| [25] | Liang S, Chau JPC, Lo SHS, et al. Implementation of ABCDEF care bundle in intensive care units:a cross-sectional survey[J]. Nurs Crit Care, 2021, 26(5):386-396. |
| [26] | Pickens CI, Wunderink RG. Principles and practice of antibio-tic stewardship in the ICU[J]. Chest, 2019, 156(1):163-171. |
| [27] | Jeffs L, Law MP, Zahradnik M, et al. Engaging nurses in optimizing antimicrobial use in ICUs:a qualitative study[J]. J Nurs Care Qual, 2018, 33(2):173-179. |
| [28] | Fung CM, Hyzy RC. Deadoption of low-value practices in the ICU[J]. Curr Opin Crit Care, 2019, 25(5):517-522. |
| [29] | Bourgault AM, Upvall MJ. De-implementation of tradition-based practices in critical care:a qualitative study[J]. Int J Nurs Pract, 2019, 25(2):e12723. |
| [30] | Atallah FC, Caruso P, Nassar A, et al. High-value care for critically ill oncohematological patients:what do we know thus far?[J]. Crit Care Sci, 2023, 35(1):84-96. |
| [31] | Kiwanuka F, Nanyonga RC, Sak-Dankosky N, et al. Nursing lea-dership styles and their impact on intensive care unit quality measures:an integrative review[J]. J Nurs Manag, 2021, 29(2):133-142. |
| [32] | Wong A, Young AT, Liang AS, et al. Development and valida-tion of an electronic health record-based machine learning model to estimate delirium risk in newly hospitalized patients without known cognitive impairment[J]. JAMA Netw Open, 2018, 1(4):e181018. |
| [33] | 来勇臣, 叶舟, 夏涛. 基于互联网+远程重症监护e-ICU系统创新设计与应用[J]. 中国数字医学, 2018, 13(7):43-45. |
| Lai YC, Zhou Y, Xia T. The innovative design and applica-tion of e-ICU system based on Internet + remote intensive care[J]. Chin Digital Med, 2018, 13(7):43-45. |
/
| 〈 |
|
〉 |