Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study

Mangino, Julie E.; Peyrani, Paula; Ford, Kimbal D.; Kett, Daniel H.; Zervos, Marcus J.; Welch, Verna L; Scerpella, Ernesto G.; Ramirez, Julio A.

doi:10.1186/cc9988

Cited by 29 publications

(25 citation statements)

References 24 publications

(53 reference statements)

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“…5,19 Guideline concordant therapy was defined as triple coverage with both anti-MRSA and two anti-pseudomonal antibiotics which is different than our study. Similarly, we did not establish benefit with triple therapy in the interaction between CAPresistance and treatment or in the ecological analysis.…”

Section: Discussionmentioning

confidence: 90%

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Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

et al. 2012

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Section: Discussionmentioning

confidence: 90%

“…5,[14][15][16][17][18][19] El Sohl et. al retrospectively stratified 344 nursing home patients based on treatment with HCAP or CAP guideline concordant therapy.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

et al. 2012

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“…Our study has several strengths, including a well-characterized study population with clinical and laboratory information available for analysis (16). IMPACT-HAP is a performance improvement project designed to better the management of ICU patients with HAP (including VAP and HCAP), which allowed us to explore the effect of a variety of pathogen-and host-related factors that can influence the clinical outcome of MRSA pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…For example, patients at risk for resistant organisms were to receive broad-spectrum empirical therapy that included an agent active against MRSA. The development and implementation of this performance improvement project have been described previously (16 (2) were entered into the database. For each case, investigators completed a data collection form and internally validated the information before transferring it via the internet to the IMPACT-HAP coordinating center at the University of Louisville.…”

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confidence: 99%

Analysis of Pathogen and Host Factors Related to Clinical Outcomes in Patients with Hospital-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus

et al. 2012

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dMethicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial pneumonia. To characterize pathogen-derived and host-related factors in intensive care unit (ICU) patients with MRSA pneumonia, we evaluated the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) database. We performed multivariate regression analyses of 28-day mortality and clinical response using univariate analysis variables at a P level of <0.25. In isolates from 251 patients, the most common molecular characteristics were USA100 (55.0%) and USA300 (23.9%), SCCmec types II (64.1%) and IV (33.1%), and agr I (36.7%) and II (61.8%). Panton-Valentine leukocidin (PVL) was present in 21.9%, and vancomycin heteroresistance was present in 15.9%. Mortality occurred in 37.1% of patients; factors in the univariate analysis were age, APACHE II score, AIDS, cardiac disease, vascular disease, diabetes, SCCmec type II, PVL negativity, and higher vancomycin MIC (all P values were <0.05). In multivariate analysis, independent predictors were APACHE II score (odds ratio [OR], 1.090; 95% confidence interval [CI], 1.041 to 1.141; P < 0.001) and age (OR, 1.024; 95% CI, 1.003 to 1.046; P ‫؍‬ 0.02). Clinical failure occurred in 36.8% of 201 evaluable patients; the only independent predictor was APACHE II score (OR, 1.082; 95% CI, 1.031 to 1.136; P ‫؍‬ 0.002). In summary, APACHE II score (mortality, clinical failure) and age (mortality) were the only independent predictors, which is consistent with severity of illness in ICU patients with MRSA pneumonia. Interestingly, our univariate findings suggest that both pathogen and host factors influence outcomes. As the epidemiology of MRSA pneumonia continues to evolve, both pathogen-and host-related factors should be considered when describing epidemiological trends and outcomes of therapeutic interventions. Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired pneumonia (HAP), ventilatorassociated pneumonia (VAP), and health care-associated pneumonia (HCAP) (26). These infections are associated with significant morbidity, mortality, and cost burdens (3,20,25).While previous studies have attempted to identify risk factors for morbidity and mortality in patients with MRSA infections, they have typically focused on either the pathogen or the host. For example, severity of underlying illness, septic shock, age, comorbidities, and other selected host-related factors appear to be independent predictors of poor outcomes (5-7, 10, 14). MRSA features associated with poor prognosis in a variety of infection types include increases in vancomycin MIC, vancomycin heteroresistance, presence of Panton-Valentine leukocidin (PVL), agr group I, individual genes, and persistent colonization (1, 9, 11, 27). Because the outcomes of MRSA pneumonia are probably due to a combination of factors, studies are needed to evaluate the combined roles of MRSA-derived and host-related factors in a large sample of patients with HAP, VAP, or HCAP ...

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“…Checklists help minimize complications of respiratory failure, improve mechanical ventilator management, decrease adverse events, and improve communication (6)(7)(8). Although checklists have been established in critical care, use outside and before admission to the intensive care unit (ICU) is variable (9), especially given that patients often develop respiratory failure and critical illness in other areas of the hospital.…”

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confidence: 99%

Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique

et al. 2016

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Rationale: Respiratory failure represents a major risk for morbidity and mortality. Although generally managed in the intensive care unit (ICU), respiratory failure often begins elsewhere. Checklists of care processes to minimize the duration of mechanical ventilation and adverse events are routinely used in the ICU, but are uncommonly used outside the ICU.Objectives: To develop consensus among a multidisciplinary expert panel on care practices to include in a checklist of best practices for critically ill patients with respiratory failure before and after ICU admission.Methods: A multidisciplinary expert panel was assembled. The panel was tasked with creating a checklist of care processes aimed at decreasing progression to respiratory failure, duration of mechanical ventilation, mortality in mechanical ventilation, and adverse events. Over the course of multiple teleconferences and e-mail communications, the Prevention of Organ Failure Checklist list was reviewed, refined, and voted upon. Items that received greater than 75% of the vote were included in the final checklist.Measurements and Main Results: Using a modified Delphi process, the expert panel was able to compile Prevention of Organ Failure Checklist into 20 items that aimed to decrease mechanical ventilation by assessing the causes of acute respiratory failure, ventilation strategies, sedation, and general critical care processes, as well as to avoid unwanted or nonbeneficial interventions. Conclusions:The modified Delphi process identified readily available preventative interventions suitable for checklist implementation in patients with or progressing to respiratory failure even before ICU admission.

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Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study

Cited by 29 publications

References 24 publications

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

Analysis of Pathogen and Host Factors Related to Clinical Outcomes in Patients with Hospital-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus

Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique

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