Purpose

Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare’s carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs.

Methods

We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles. We recorded impacts on the low-value target, health outcomes, resource use, cost, and the environment.

Results

From 1155 studies screened, 32 eligible studies were identified evaluating interventions to reduce: routine blood testing (n = 13), routine chest X-rays (n = 10), and other types (or multiple types) of low-value care (n = 9). All but 3 of the interventions found reductions in the immediate low-value care target (usually the primary outcome). Although the small sample size of most included studies, limited their ability to detect impacts on other outcomes, many interventions were also associated with improved health outcomes and financial savings. The only study that reported environmental impacts found the intervention was associated with reduced carbon dioxide equivalent (CO₂-e) emissions.

Conclusions

Interventions to reduce low-value care in ICUs may have important health, financial, and environmental co-benefits. Further research may inform wider scale-up and sustainability of successful strategies to decrease low-value healthcare. More empirical evidence on potential environmental benefits may inform policies to lower healthcare’s carbon footprint.

中文翻译：

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减少重症监护环境中低价值护理的干预措施：对健康、资源使用、成本和环境影响的范围界定审查

 目的

低价值护理在重症监护病房 （ICU） 中很常见，不必要地使患者面临风险和伤害，给患者和医疗保健系统带来成本，并导致医疗保健的碳足迹。我们旨在识别、整理和总结已发表的关于干预措施对减少 ICU 低价值护理影响的证据。

 方法

我们检索了从建库到2023年9月22日的MEDLINE、Embase和Cochrane CENTRAL，以评估旨在减少低价值护理的干预措施，并辅以参考文献列表和最近发表的文章。我们记录了对低价值目标、健康结果、资源使用、成本和环境的影响。

 结果

从筛选的 1155 项研究中，确定了 32 项符合条件的研究，评估了减少的干预措施：常规血液检查 （n = 13）、常规胸部 X 光检查 （n = 10） 和其他类型的 （或多种类型） 低价值护理 （n = 9）。除 3 项干预措施外，所有干预措施都发现直接低价值护理目标（通常是主要结局）减少。尽管大多数纳入研究的样本量小，限制了它们检测对其他结局影响的能力，但许多干预措施也与改善健康结局和节省财务有关。唯一报告环境影响的研究发现，该干预措施与二氧化碳当量 （CO_2-e） 排放减少有关。

 结论

减少 ICU 中低价值护理的干预措施可能具有重要的健康、财务和环境协同效益。进一步的研究可能会为减少低价值医疗保健的成功策略的更广泛扩大和可持续性提供信息。关于潜在环境效益的更多实证证据可能会为降低医疗保健碳足迹的政策提供信息。