Chinese Journal of Emergency and Critical Care Nursing >
Construction and applicability analysis of low-value care lists for critically ill patients
Received date: 2025-04-17
Online published: 2026-04-02
Objective To construct a list of low-value care items for critically ill patients based on evidence-based evidence，so as to provide a reference for the de-implementation of low-value care items in critically ill patients. Methods Systematic searches were conducted in Chinese and English databases，and guidelines related websites，with the search time limit from January 1，2015，to March 1，2025. Two researchers independently performed quality evaluation，extracted and summarized the nursing items explicitly not recommended in the literature. A list of low-value items in critical care was formed through two rounds of expert consultation. Results A total of 26 literatures was included，including 10 guidelines，1 evidence summary，and 15 expert consensuses. The effective response rates of the two rounds of consultation questionnaires were 88.89% and 100%，respectively，with expert authority coefficients of 0.897 and 0.925. The Kendall’s concordance coefficients for item importance were 0.247 and 0.394（P < 0.05）. Finally，60 low-value care items were formed. Conclusion The list of low-value care items for critically ill patients constructed based on evidence-based evidence can guide critical care staff to reduce the implementation of related items in their work，improve nursing quality，and avoid resource waste.
WANG Chaoping , YUAN Weiwei , CHEN Junxi , GU Tiantian , YUAN Xiaoli . Construction and applicability analysis of low-value care lists for critically ill patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026 , 7(4) : 462 -468 . DOI: 10.3761/j.issn.2096-7446.2026.04.014
| [1] | Rockwell MS, Michaels KC, Epling JW. Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study[J]. BMC Health Serv Res, 2022, 22(1):37. |
| [2] | Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system:estimated costs and potential for savings[J]. JAMA, 2019, 322(15):1501-1509. |
| [3] | 张莹, 瞿志强, 侯志远. 国际医疗领域“明智选择” 运动的进展及其对我国的启示[J]. 医学与社会, 2024, 37(9):1-5. |
| Zhang Y, Qu ZQ, Hou ZY. Progress of the ‘choosing wisely’ cam-paign in the field of international healthcare and its impli-cations to China[J]. Med Soc, 2024, 37(9):1-5. | |
| [4] | Ingvarsson S, Hasson H, Augustsson H, et al. Management stra-tegies to de-implement low-value care-an applied behavior analysis[J]. Implement Sci Commun, 2022, 3(1):69. |
| [5] | 宋亚奇, 钟娟平, 程斐然, 等. 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. |
| Song YQ, Zhong JP, Cheng FR, et al. Research progress in the field of de-implementation of low-value care in the field of critical care[J]. Chin J Emerg Crit Care Nurs, 2025, 6(1):65-69. | |
| [6] | 胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018. |
| Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018. | |
| [7] | Chaves F, Garnacho-Montero J, Del Pozo JL, et al. Diagnosis and treatment of catheter-related bloodstream infection:Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and(SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units(SEMICYUC)[J]. Med Intensiva, 2018, 42(1):5-36. |
| [8] | Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy stan-dards of practice,8th edition[J]. J Infus Nurs, 2021, 44(1S Suppl 1):S1-S224. |
| [9] | Rosenthal VD, Memish ZA, Nicastri E, et al. Preventing catheter-associated urinary tract infections:a position paper of the International Society for Infectious Diseases,2024 update[J]. Int J Infect Dis, 2025, 151:107304. |
| [10] | 邓子银, 刘加婷, 赵丽蓉, 等. 成人患者经鼻胃管喂养临床实践指南(2023年更新版)[J]. 护士进修杂志, 2024, 39(7):673-679. |
| Deng ZY, Liu JT, Zhao LR, et al. The clinical practice guide for nasogastric tube feeding in adult patients(2023 update version)[J]. J Nurses Train, 2024, 39(7):673-679. | |
| [11] | 国家急诊医学专业医疗质量控制中心. 急危重症患者鼻空肠营养管管理专家共识[J]. 中华急诊医学杂志, 2024, 33(6):761-766. |
| National Center for Medical Quality Control in Emergency Medicine. Expert consensus on the management of nasojejunal feeding tubes in critically ill patients[J]. Chin J Emerg Med, 2024, 33(6):761-766. | |
| [12] | 马玉芬, 成守珍, 刘义兰, 等. 卧床患者常见并发症护理专家共识[J]. 中国护理管理, 2018, 18(6):740-747. |
| Ma YF, Cheng SZ, Liu YL, et al. A consensus statement on nursing care of major immobility complications among bedrid-den patients[J]. Chin Nurs Manag, 2018, 18(6):740-747. | |
| [13] | 国家卫生健康委办公厅. 血管导管相关感染预防与控制指南(2021版)[J]. 中国感染控制杂志, 2021, 20(4):387-388. |
| General Office of the National Health Commission(NHC). Guidelines for the prevention and control of vessel catheter associated infection(2021 Edition)[J]. Chin J Infect Contr, 2021, 20(4):387-388. | |
| [14] | 杨启文, 吴安华, 胡必杰, 等. 临床重要耐药菌感染传播防控策略专家共识[J]. 中国感染控制杂志, 2021, 20(1):1-14. |
| Yang QW, Wu AH, Hu BJ, et al. Expert consensus on strate-gies for the prevention and control of spread of clinically important antimicrobial-resistant organisms[J]. Chin J Infect Contr, 2021, 20(1):1-14. | |
| [15] | 中国重症血液净化协作组. 中国重症血液净化护理专家共识(2021年)[J]. 中华现代护理杂志, 2021, 27(34):4621-4632. |
| China Critical Care Blood Purification Cooperation Group. Expert consensus on the nursing of critical blood purification in China(2021)[J]. Chin J Mod Nurs, 2021(34):4621-4632. | |
| [16] | 中华护理学会重症护理专业委员会. 成人重症患者颅内压增高防控护理专家共识[J]. 中华护理杂志, 2024, 59(21):2606-2610. |
| Critical Care Nursing Committee of Chinese Nursing Associa-tion. Expert consensus on the prevention and control of intra-cranial hypertension in adult critical illness[J]. Chin J Nurs, 2024, 59(21):2606-2610. | |
| [17] | 李素云, 邵小平, 唐小丽, 等. 肠外营养安全输注专家共识[J]. 中华护理杂志, 2022, 57(12):1421-1426. |
| Li SY, Shao XP, Tang XL, et al. Expert consensus on paren-teral nutrition safety infusion[J]. Chin J Nurs, 2022, 57(12):1421-1426. | |
| [18] | 中心静脉导管冲管及封管共识专家组. 中心静脉导管冲管及封管专家共识[J]. 中华急诊医学杂志, 2022, 31(4):442-447. |
| Expert Consensus Group on Flushing and Sealing of Central Venous Catheters. Expert consensus on flushing and sealing of central venous catheters[J]. Chin J Emerg Med, 2022, 31(4):442-447. | |
| [19] | 亚洲急危重症协会中国腹腔重症协作组. 重症患者中心静脉导管管理中国专家共识(2022版)[J]. 中华消化外科杂志, 2022(3):313-322. |
| Chinese Abdominal Intensive Care Association of Asia Emer-gency and Critical Care Medicine Society. Chinese expert consensus on management of central venous catheters for critically ill patients(2022 edition)[J]. Chin J Dig Surg, 2022(3):313-322. | |
| [20] | Health Quality & Safety Commission New Zealand. Guiding principles for pressure injury prevention and management in New Zealand,2017[EB/OL].(2017-05-01)[2025-03-02]. https://www.nzwcs.org.nz/resources/publications/10-guidelines-and-proto-cols. |
| [21] | Kottner J, Cuddigan J, Carville K, et al. Prevention and treat-ment of pressure ulcers/injuries:the protocol for the second update of the international Clinical Practice Guideline 2019[J]. J Tissue Viability, 2019, 28(2):51-58. |
| [22] | 中华医学会神经外科分会, 中国神经外科重症管理协作组. 中国神经外科重症患者营养治疗专家共识(2022版)[J]. 中华医学杂志, 2022, 102(29):2236-2255. |
| Neurosurgery Branch of Chinese Medical Association, China Neurosurgery Critical Care Management Collaborative Group. Chinese expert consensus on management of central venous catheters for critically ill patients(2022 edition)[J]. Chin J Digest Surg, 2022, 102(29):2236-2255. | |
| [23] | 中华医学会重症医学分会. 中国成人ICU患者营养评估与监测临床实践指南[J]. 中华危重病急救医学, 2023, 35(11):1121-1146. |
| Critical Care Medicine Branch of Chinese Medical Associa-tion. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China[J]. Chin Crit Care Med, 2023, 35(11):1121-1146. | |
| [24] | 孙仁华, 江荣林, 黄曼, 等. 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. |
| Sun RH, Jiang RL, Huang M, et al. Consensus of early enteral nutrition clinical practice in critically ill patients[J]. Chin Critic Care Med, 2018, 30(8):715-721. | |
| [25] | 中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版)[J]. 中华消化外科杂志, 2020, 19(10):1030-1037. |
| Chinese Abdominal Intensive Care Association. Expert con-sensus on monitoring and management of intra-abdominal hypertension in severe patients(2020 edition)[J]. Chin J Di-gest Surg, 2020, 19(10):1030-1037. | |
| [26] | 李志茹, 王华芬, 卢芳燕. 危重症患者腹内压监测的最佳证据总结[J]. 中国护理管理, 2022, 22(5):750-754. |
| Li ZR, Wang HF, Lu FY. Summary of the best evidence for monitoring intra-abdominal pressure in critically ill patients[J]. Chin Nurs Manag, 2022, 22(5):750-754. | |
| [27] | 《成人气管切开拔管中国专家共识》编写组. 成人气管切开拔管中国专家共识(上)[J]. 中华物理医学与康复杂志, 2023, 45(6):481-487. |
| Writing Group of Chinese Expert Consensus on Adult Tra-cheostomy Decannulation. Chinese expert consensus on adult tracheostomy decannulation(Part 1)[J]. Chin J Phys Med Re-habil, 2023, 45(6):481-487. | |
| [28] | 许娟, 莫蓓蓉, 胡玉娜, 等. 重症监护病房成人患者护理人文关怀专家共识[J]. 护理学杂志, 2022, 37(18):1-4. |
| Xu J, Mo BR, Hu YN, et al. Expert consensus on nursing human caring for ICU adult patients[J]. J Nurs Sci, 2022, 37(18):1-4. | |
| [29] | Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice gui-delines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. Crit Care Med, 2018, 46(9):e825-e873. |
| [30] | 国家神经系统疾病医疗质量控制中心神经重症亚专业工作组. 神经重症患者镇痛镇静治疗中国专家共识(2023)[J]. 中华危重病急救医学, 2023, 35(9):897-918. |
| Neurological Critical Care Subspecialty Working Group of the National Center for Healthcare Quality Management in Neu-rological Diseases. Chinese expert consensus on analgosedation in neurocritical care patients(2023)[J]. Chin Critic Care Med, 2023, 35(9):897-918. | |
| [31] | Duranteau J, Taccone FS, Verhamme P, et al. European guide-lines on perioperative venous thromboembolism prophylaxis:Intensive care[J]. Eur J Anaesthesiol, 2018, 35(2):142-146. |
| [32] | Wu ZX, Liu J, Zhang D, et al. Expert consensus on the glyce-mic management of critically ill patients[J]. J Intensive Med, 2022, 2(3):131-145. |
| [33] | Zou JF, Zheng LL, Shuai WZ, et al. Comparison of intra-abdo-minal pressure measurements in critically ill patients using intravesical normal saline at 15 ℃,25 ℃,and 35℃[J]. Med Sci Monit, 2021, 27:e932804. |
/
| 〈 |
|
〉 |