1. Section Editor(s): Barto, Donna DNP, RN, CCRN

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On his first day in office, President Donald Trump signed an executive order to scale back the Affordable Care Act. His intent was to try to reduce costs and the burden on consumers.1 However, the debate over healthcare coverage is far from over. Whatever your politics, I think we can all agree that healthcare coverage should be affordable and of high quality for all. We as healthcare providers have the power to carry this out right now despite what is going on in the political world.

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The American Board of Internal Medicine Foundation's Choosing Wisely initiative is a national campaign that began in 2012.2 The concept behind the campaign is that more healthcare isn't always better; we need to look at decreasing the overuse of medical testing and reducing treatments that are not necessary. Specialty organizations were challenged to compare their practices and the evidence and come up with a list of at least five diagnostic tests or treatments that were commonly ordered, but not always necessary. Since the initiative began, more than 70 specialty organizations have released recommendations that facilitate wise decisions about the appropriate care to give patients and their families. These recommendations can be found on and are written for healthcare providers as well as the general public.


The top five recommendations for critical care were developed by four professional critical care societies, including the American Association of Critical-Care Nurses. The top five critical care services that patients and healthcare providers should question are:


1. Ordering diagnostic tests at regular intervals rather than to answer specific clinical questions


2. Transfusing red blood cells in hemodynamically stable, nonbleeding patients with a hemoglobin concentration of 7 g/dL or greater


3. Using parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay


4. Deeply sedating mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation


5. Continuing life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families comfort care as an alternative.



Choosing Wisely has no political affiliations and is meant to provide quality care at minimal cost for the best outcomes for patients and their families. I ask all of you to consider the top-five list above and start choosing wisely in your clinical practice setting.



1. Davis JH, Pear R. Trump issues executive order scaling back parts of Obamacare. New York Times. 2017. [Context Link]


2. Choosing Wisely: an initiative of the ABIM Foundation. 2017. [Context Link]



Angus DC, Deutschman CS, Hall JB, Wilson KC, Munro CL, Hill NS. Choosing wisely in critical care: maximizing value in the intensive care unit. Am J Crit Care. 2014;23(6):444-446.


Donna Barto, DNP, RN, CCRN