Your browser doesn't support javascript.
loading
A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care.
de Vos, Maartje L G; van der Veer, Sabine N; Wouterse, Bram; Graafmans, Wilco C; Peek, Niels; de Keizer, Nicolette F; Jager, Kitty J; Westert, Gert P; van der Voort, Peter H J.
Afiliación
  • de Vos ML; Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, PO Box 90153, , 5000 LE, Tilburg, The Netherlands. mdevos@amphia.nl.
  • van der Veer SN; Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, PO Box 1, , 3720 BA, Bilthoven, The Netherlands. mdevos@amphia.nl.
  • Wouterse B; Department of Medical Informatics, Academic Medical Center, PO Box 22660, , 1100 DD, Amsterdam, The Netherlands. s.n.vanderveer@amc.nl.
  • Graafmans WC; Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, PO Box 90153, , 5000 LE, Tilburg, The Netherlands. b.wouterse@cpb.nl.
  • Peek N; Center for Public Health Forecasting, National Institute for Public Health and the Environment, PO Box 1,, 3720 BA, Bilthoven, The Netherlands. b.wouterse@cpb.nl.
  • de Keizer NF; Health Strategy and Health Systems Unit, European Commission, Brussels, Belgium. wgraafmans@zinl.nl.
  • Jager KJ; Health e-Research Centre, The University of Manchester, Manchester, UK. n.b.peek@amc.uva.nl.
  • Westert GP; Department of Medical Informatics, Academic Medical Center, PO Box 22660, , 1100 DD, Amsterdam, The Netherlands. n.f.keizer@amc.uva.nl.
  • van der Voort PH; Department of Medical Informatics, Academic Medical Center, PO Box 22660, , 1100 DD, Amsterdam, The Netherlands. k.j.jager@amc.uva.nl.
Implement Sci ; 10: 95, 2015 Jul 08.
Article en En | MEDLINE | ID: mdl-26152568
BACKGROUND: Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards. METHODS: In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs. RESULTS: We analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62-1.27) or compared to control group (OR 0.67; 95 % CI 0.39-1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41-1.26 compared to baseline and OR 0.65; 95 % CI 0.35-1.19 compared to control group). CONCLUSIONS: A multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up. ISRCTN: ISRCTN50542146.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Adhesión a Directriz / Retroalimentación / Unidades de Cuidados Intensivos Tipo de estudio: Clinical_trials / Guideline Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Implement Sci Año: 2015 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Adhesión a Directriz / Retroalimentación / Unidades de Cuidados Intensivos Tipo de estudio: Clinical_trials / Guideline Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Implement Sci Año: 2015 Tipo del documento: Article País de afiliación: Países Bajos