Table 1.

Known and potential sources of ICU waste

Category of waste	Examples	Research approaches	Relevance
Inappropriate ICU admission for patients who   will not benefit relative to ward admission	Patients potentially too well to benefit from   ICU: DKA, non-massive PE, CHF exacerbation   without MV	Nuanced comparison of ICU and ward cohorts	Greatest potential waste reduction
	Patients potentially too sick to benefit from ICU:   some non-modifiable end-stage diseases	Personalized predictive modeling for risk of   decompensation, response to therapies, and   outcomes
Deploying low-value care for patients appropri-   ately admitted to the ICU	Known: standing diagnostic tests, unneces-   sary RBC transfusions, early TPN, excessive   sedation, continued life support without   discussions of comfort-based approaches for   appropriately ill patients	Comparative effectiveness research focused on   interventions that are expensive, obvious bar-   riers to other good outcomes, or are of high   risk to patients	Non-maleficence: patients avoid ineffective   interventions
	Potential: serial ABGs for MV patients, arterial   catheters for hemodynamic monitoring, brain   imaging for non-focal AMS, routine TTEs for   shock
Unnecessarily prolonging ICU length of stay	Failure to discharge when ICU care no longer   better than ward care	Reduction in ward strain to facilitate timely ICU   discharge	Reduce long-term sequelae of critical illness
	Failure to deploy interventions that shorten   critical illness/ICU LOS	Personalized predictive modeling for post-ICU   outcomes

ABG arterial blood gas, AM altered mental status, CHF congestive heart failure, DKA diabetic ketoacidosis, ICU intensive care unit, LOS length-of-stay, MV mechanical ventilation, PE pulmonary embolism, RBC red blood cell, TPN total parenteral nutrition, TTE transthoracic echocardiogram