Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients*

Nachtigall, Irit; Tamarkin, Andrey; Tafelski, Sascha; Deja, Maria; Halle, E.; Gastmeier, Petra; Wernecke, Klaus D.; Bauer, Torsten T.; Kastrup, Marc; Spies, Claudia

doi:10.1097/ccm.0b013e3181934f1b

Cited by 68 publications

(57 citation statements)

References 37 publications

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“…Implementation rates are often inadequate. Considering that 10% of the patients did not receive prompt treatment for delirium -and an implementation rate of 70% is usually considered sufficient for quality management 27 -there should be different implementation rates for different ICU treatments, because an elevated mortality risk was observed in the 10% of patients who were not treated immediately.…”

Section: Discussionmentioning

confidence: 99%

Delayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients

Heymann¹,

Radtke²,

Schiemann

et al. 2010

J Int Med Res

115

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Delirium in the intensive care unit (ICU)is a serious complication associated with a poor outcome in critically ill patients. In this prospective observational study of the effect of a delay in delirium therapy on mortality rate, 418 ICU patients were regularly assessed using the Delirium Detection Score (DDS). The departmental standard required that if delirium was diagnosed (DDS > 7), therapy should be started within 24 h. In total, 204 patients (48.8%) were delirious during their ICU stay. In 184 of the delirious patients (90.2%), therapy was started within 24 h; in 20 patients (9.8%), therapy was delayed. During their ICU stay, patients whose delirium treatment was delayed were more frequently mechanically ventilated, had more nosocomial infections (including pneumonia) and had a higher mortality rate than patients whose treatment was not delayed. Thus, it would appear that a delay in initiating delirium therapy in ICU patients was associated with increased mortality.

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Section: Discussionmentioning

confidence: 99%

Delayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients

Heymann¹,

Radtke²,

Schiemann

et al. 2010

J Int Med Res

115

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“…Only patients with an ICU treatment >36 h and with more than two blood sugar measurements performed were included for analysis. To a priori exclude the confounding factor of anti-infective treatment, 19,20 an additional inclusion criterion was quality of anti-infective treatment. The study cohort included patients with sufficient anti-infective control (comprising diagnostic and therapeutic procedures) defined as >65% adherence to guidelines and local standards.…”

Section: Study Population and Designmentioning

confidence: 99%

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

et al. 2015

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Objective: To evaluate the safety profile of blood sugar limits in intensive care unit (ICU) patients. Methods: Adult patients with ICU stay >36 h, more than two blood sugar measurements and antibiotic therapy concordant with locally adapted guidelines were included. For analyses, one study cohort was defined in two ways: as a narrow group, euglycaemic patients' blood sugar levels 80-150 mg/dl; as a moderate group, euglycaemic patients' blood sugar levels 80-180 mg/dl. Dysglycaemia was defined as blood sugar levels <80 mg/dl for >5% of measurements, and >150 mg/dl or >180 mg/dl (narrow or moderate groups, respectively) for >10% of measurements. The primary endpoint was ICU mortality (euglycaemia versus dysglycaemia). Results: The study comprised 668 patients. When defined as a narrow group, ICU mortality was 3% (four of 135) euglycaemic versus 10% (54/533) dysglycaemic patients (odds ratio [OR] 3.692, 95% confidence interval [CI] 1.313, 10.382). When defined as a moderate group, ICU mortality was 6% (21/351) euglycaemic versus 12% (37/317) dysglycaemic patients (OR 2.077, 95% CI 1.188, 3.630). Frequency of severe hypoglycaemia (blood sugar <40 mg/dl) was not different between the narrow and moderate euglycaemic ranges. Conclusions: Euglycaemia was associated with lower ICU mortality than dysglycaemia, and incidence of hypoglycaemia was low overall in this study. Based on current published evidence, therapeutic targets should be defined according to individual patient characteristics.

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“…Members of the data monitoring expert committee had open access to all patient data, to scrutinize the data randomly and re-evaluate the adherence to protocol independently from the study team, as previously described in similar study protocols. 10,19,20 …”

Section: Data Collection and Expert Review Processmentioning

confidence: 99%

“…A previous study achieved a 60 -70% SOP adherence rate by dividing the number of ICU days with SOP adherent treatment by the number of total ICU days (LOT). 20 In this context, the primary study aim was to evaluate ICU mortality rates by comparing a low adherence group (LAG) and a high adherence group (HAG), based on the threshold of 60% adherence. Based on a day-by-day analysis, LAG status comprised patients with < 60% of their ICU days being evaluated as conforming with SOP regarding infection management, whereas HAG status defined patients with ≥ 60% of their ICU days without any SOP violation.…”

Section: Group Assignment and Study Aimsmentioning

confidence: 99%

“…19 All criteria used in this evaluation process are published in detail elsewhere. 10,19,20 Following analysis of the level of conformity of anti-infective therapy to locally adapted SOP, data were audited by an additional independent data monitoring expert committee. This second data audit was performed to confirm the results of the first team.…”

Section: Data Collection and Expert Review Processmentioning

confidence: 99%

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Computer-Assisted Decision Support for Changing Practice in Severe Sepsis and Septic Shock

et al. 2010

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Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre-and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan-Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.

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Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients*

Abstract: Adherence to standard operating procedure is associated with a shorter duration of treatment of first pneumonia episode, a shorter duration of mechanical ventilation, and a shorter ICU stay.

Cited by 68 publications

References 37 publications

Delayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients

Delayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients

Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation

Computer-Assisted Decision Support for Changing Practice in Severe Sepsis and Septic Shock

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