Featured Research

from universities, journals, and other organizations

Quality improvement intervention for ICUs results in increased use of evidence-based care practices

Date:
January 19, 2011
Source:
JAMA and Archives Journals
Summary:
A multifaceted quality improvement intervention that included education, reminders and feedback through a collaborative telecommunication network improved the adoption of evidenced-based care practices in intensive care units at community hospitals for practices such as preventing catheter-related bloodstream infections and ventilator-associated pneumonia, according to a new study.

A multifaceted quality improvement intervention that included education, reminders and feedback through a collaborative telecommunication network improved the adoption of evidenced-based care practices in intensive care units at community hospitals for practices such as preventing catheter-related bloodstream infections and ventilator-associated pneumonia, according to a study that will appear in the January 26 issue of JAMA.

Related Articles


Despite expensive life-sustaining technologies, the risk of death and complication rates in critically ill patients remains high. "Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them," according to background information in the article. "… nonacademic hospitals face larger barriers to implementing evidence-based care because of heavier individual clinician workloads and fewer personnel devoted to collaborative continuing educational activities."

Damon C. Scales, M.D., Ph.D., of the University of Toronto and Sunnybrook Health Sciences Centre, Toronto, and colleagues conducted a randomized trial to determine whether a quality improvement intervention could increase the adoption of 6 evidence-based ICU care practices. The study included 15 community hospital ICUs in Ontario, Canada, with a total of 9,269 admissions occurring during the trial (November 2005 to October 2006).

The intervention consisted of a videoconference-based forum including audit and feedback, expert-led educational sessions, and reminders (such as posters and checklists). Intensive care units were randomized into 2 groups. Each group received the intervention, targeting a new practice every 4 months, while acting as a control for the other group, in which a different practice was targeted in the same period. The 6 practices that were included in study were: prevention of ventilator-associated pneumonia (VAP); prevention of deep vein thrombosis (DVT); sterile precautions for central venous catheter insertion to prevent catheter-related bloodstream infections; daily spontaneous breathing trials to decrease duration of mechanical ventilation; early enteral nutrition (feeding tube); and daily assessment of risk for developing decubitus (pressure) ulcers.

The researchers found that, including all hospitals and targeted care practices, patients in ICUs receiving active intervention were more likely to receive the targeted care practice than those in control ICUs. Improved delivery in intervention ICUs was greatest for semirecumbent positioning to prevent ventilator-associated pneumonia (90 percent of patient-days in last month vs. 50 percent in first month) and precautions to prevent catheter-related bloodstream infection (70 percent of patients receiving central lines vs. 10.6 percent). Adoption of other practices, many with high adherence at the beginning of the study, changed little.

The authors note that this study focused on improving the quality of care for patients admitted to ICUs in community hospitals rather than academic hospitals. "Community ICUs admit the majority of critically ill patients and have fewer resources for implementing quality improvement initiatives. Our videoconferencing network is one model for helping health care workers in geographically dispersed community hospitals to improve quality by accessing resources usually restricted to academic hospitals."

"In conclusion, we found that a collaborative network of ICUs linked by a telecommunication infrastructure improved the adoption of care practices. However, improved performance among all practices was not uniform. Future large-scale quality improvement initiatives should choose practices based on measured rather than reported care gaps, consider site-specific (vs. aggregated) needs assessments to determine target care practices, and conduct baseline audits to focus on poorly performing ICUs, which have the greatest potential for improvement."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Damon C. Scales, Katie Dainty, Brigette Hales, Ruxandra Pinto, Robert A. Fowler, Neill K. J. Adhikari, Merrick Zwarenstein. Caring for the Critically Ill Patient A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units: A Cluster Randomized Trial. JAMA, January 19, 2011 DOI: 10.1001/jama.2010.2000

Cite This Page:

JAMA and Archives Journals. "Quality improvement intervention for ICUs results in increased use of evidence-based care practices." ScienceDaily. ScienceDaily, 19 January 2011. <www.sciencedaily.com/releases/2011/01/110119141731.htm>.
JAMA and Archives Journals. (2011, January 19). Quality improvement intervention for ICUs results in increased use of evidence-based care practices. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2011/01/110119141731.htm
JAMA and Archives Journals. "Quality improvement intervention for ICUs results in increased use of evidence-based care practices." ScienceDaily. www.sciencedaily.com/releases/2011/01/110119141731.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Kids Die While Under Protective Services

Kids Die While Under Protective Services

AP (Dec. 18, 2014) As part of a six-month investigation of child maltreatment deaths, the AP found that hundreds of deaths from horrific abuse and neglect could have been prevented. AP's Haven Daley reports. (Dec. 18) Video provided by AP
Powered by NewsLook.com
UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins