Multiprofessional survey of protocol use in the intensive care unit

LeBlanc, Jaclyn M.; Kane‐Gill, Sandra L.; Pohlman, Anne S.; Herr, Daniel

doi:10.1016/j.jcrc.2012.07.012

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…Numerous studies-including those in severe adult TBI 32-34successfully used multidisciplinary task forces to design clinical pathways. 15,16,29,[34][35][36][37] They included all services that would be impacted, including resistant parties in the non-hierarchical protocol development to elicit clear expectations, ownership, and commitment to its success and compliance through written 1558 BROLLIAR ET AL.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Study Exploring Factors Associated with Provider Adherence to Severe Pediatric Traumatic Brain Injury Guidelines

Brolliar

Moore

Thompson

et al. 2016

Journal of Neurotrauma

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Despite demonstrated improvement in patient outcomes with use of the Pediatric Traumatic Brain Injury (TBI) Guidelines (Guidelines), there are differential rates of adherence. Provider perspectives on barriers and facilitators to adherence have not been elucidated. This study aimed to identify and explore in depth the provider perspective on factors associated with adherence to the Guidelines using 19 focus groups with nurses and physicians who provided acute management for pediatric patients with TBI at five university-affiliated Level 1 trauma centers. Data were examined using deductive and inductive content analysis. Results indicated that three inter-related domains were associated with clinical adherence: 1) perceived guideline credibility and applicability to individual patients, 2) implementation, dissemination, and enforcement strategies, and 3) provider culture, communication styles, and attitudes towards protocols. Specifically, Guideline usefulness was determined by the perceived relevance to the individual patient given age, injury etiology, and severity and the strength of the evidence. Institutional methods to formally endorse, codify, and implement the Guidelines into the local culture were important. Providers wanted local protocols developed using interdisciplinary consensus. Finally, a culture of collaboration, including consistent, respectful communication and interdisciplinary cooperation, facilitated adherence. Provider training and experience, as well as attitudes towards other standardized care protocols, mirror the use and attitudes towards the Guidelines. Adherence was determined by the interaction of each of these guideline, institutional, and provider factors acting in concert. Incorporating provider perspectives on barriers and facilitators to adherence into hospital and team protocols is an important step toward improving adherence and ultimately patient outcomes.

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Section: Discussionmentioning

confidence: 99%

A Qualitative Study Exploring Factors Associated with Provider Adherence to Severe Pediatric Traumatic Brain Injury Guidelines

Brolliar

Moore

Thompson

et al. 2016

Journal of Neurotrauma

View full text Add to dashboard Cite

show abstract

“…The reason is that it is closely related to the patients' disease, clinical condition and diagnostics tests. Jaclyn Le Blance et al (19) conducted a study based on a questionnaire on application of a protocol in ICUs and concluded that the physicians agreed to apply the protocol to accelerate their tasks and control the costs, time, and the quality of the patients' care.Based on the results of the current study, the guidelines were prepared as the standard and valid guidelines for clinical investigations and evaluating the physicians' performance in admitting patients in medical ICUs. The data showed very low agreement between the guidelines and the experts' opinions about inappropriate admissions which indicated a need for more discussions between physicians to be convinced obeying the guidelines.…”

Section: Discussionmentioning

confidence: 99%

The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

et al. 2016

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Background: Investigating the conditions and the appropriateness of admission of patients in hospitals is an important issue which can improve the efficiency of health care delivery. Intensive care unit (ICU) is important due to applying expensive financial sources; therefore, its efficient application is of great priority. In this regard, the current study aimed to determine the financial burden of inappropriate admissions in internal intensive care units (IICUs). Methods: It was a cross-sectional study conducted in 2014. A total of 294 patients admitted to IICUs of Shahid Faghihi and Nemazee hospitals of Shiraz, Iran, in 2012 were enrolled into this retrospective study. The study was conducted in two phases, using the guidelines of American critical care association (ACCA) and experts' opinion to investigate the financial burden of inappropriate admissions in IICUs of the above-mentioned hospitals. Results:The results showed no statistically significant relationships among insurance status, insurance type, age, gender and inappropriate admission by applying Chi-square. Among 294 admitted patients under the study, the inappropriate admissions were 11.2% based on the guidelines and 13.6% based on the experts' opinion. The level of agreement of the guidelines and experts' opinion for the inappropriate admissions was 0.076 based on Kappa coefficient. The total financial burden imposed on the insurance agencies and the patients by inappropriate admissions was US$ 47867.78 based on the guidelines and US$ 83241.68 based on the experts' opinion. Conclusions: Inappropriate admissions to ICUs may impose additional costs to the health system and the patients on one hand, and deprives other patients from receiving health services. Therefore, it is crucial to effectively plan for the application of ICU beds.

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“…However, widespread adoption is hindered by the lack of available expertise at the bedside. ICU care protocols are often complicated and time consuming, and dedicated personnel to facilitate protocol and checklist adherence are typically unavailable (6). …”

Section: Introductionmentioning

confidence: 99%

Impact of Nurse-Led Remote Screening and Prompting for Evidence-Based Practices in the ICU*

Kahn

Gunn

Lorenz

et al. 2014

Critical Care Medicine

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Objective Evidence-based practices are not consistently applied in the intensive care unit (ICU). We sought to determine if nurse-led remote screening and prompting for evidence-based practices using an electronic health record could impact ICU care delivery and outcomes in an academic medical center. Design Single-center, before-after evaluation of a quality improvement project. Setting Urban, academic medical center in the mid-Atlantic United States with 8 subspecialty ICUs and 156 ICU beds. Patients Adult patients admitted to the ICU between January 1, 2011 and August 31, 2012. Intervention Beginning on July 25, 2011, trained ICU nurses screened all ICU patients for selected evidence-based practices on a daily basis. The screening was conducted from a remote office, facilitated by the electronic health record. Selected practices included compliance with a ventilator care bundle, assessment of appropriateness of indwelling venous and urinary catheters, and concordance between sedation orders and documented level of sedation. When gaps were observed they were communicated to the point-of-care bedside nurse via telephone, page or facsimile. Measurements and Main Results 14,823 unique patients were admitted during the study period. We excluded 1,546 patients during a 2-month run-in period from July 1, 2011 to August 31, 2011, resulting in 4,339 patients in the 6-month pre-intervention period and 8,938 patients in the 12-month post-intervention period. Compared to patients admitted in the pre-intervention period, patients admitted in the post-intervention period were more likely to receive sedation interruption (incidence rate ratio: 1.57, 95% CI: 1.45 – 1.71) and a spontaneous breathing trial (incidence rate ratio: 1.24, 95% CI: 1.20 – 1.29). Hospital acquired infection rates were not different between the two periods. Adjusting for patient characteristics and illness severity, patients in the post-intervention period experienced shorter duration of mechanical ventilation (adjusted reduction: 0.61 days, 95% CI: 0.27 – 0.96, p <0.001), shorter ICU length of stay (adjusted reduction: 0.22 days, 95% CI: 0.04 – 0.41, p=0.02), and shorter hospital length of stay (adjusted reduction: 0.55 days, 95% CI: 0.15 – 0.93, p=0.006). In-hospital mortality was unchanged (adjusted odds ratio: 0.96, 95% CI 0.84 – 1.09, p=0.54). The results were robust to tests for concurrent temporal trends and coincident interventions. Conclusions A program by which nurses screened ICU patients for best-practices from a remote location was associated with improvements in the quality of care and reductions in duration of mechanical ventilation and length of stay, but had no impact on mortality.

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Multiprofessional survey of protocol use in the intensive care unit

Cited by 15 publications

References 26 publications

A Qualitative Study Exploring Factors Associated with Provider Adherence to Severe Pediatric Traumatic Brain Injury Guidelines

A Qualitative Study Exploring Factors Associated with Provider Adherence to Severe Pediatric Traumatic Brain Injury Guidelines

The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

Impact of Nurse-Led Remote Screening and Prompting for Evidence-Based Practices in the ICU*

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