Abstract | BACKGROUND: The use of a "quality rounds checklist" (QRC) is an effective tool for improving compliance with evidence-based preventative measures and outcomes in the surgical intensive care unit (SICU). Our aim was to evaluate the long-term sustainability and outcome impact of this quality improvement strategy. METHODS: Prospective observational study evaluates the use of the QRC in the SICU from July 2009 to June 2011. Daily compliance with evidence-based prophylactic measures was assessed using the QRC and reviewed monthly at a multidisciplinary meeting. Logistic regression was performed to evaluate patterns of compliance over time. Current compliance was compared with previously reported rates, and the impact on outcomes including catheter-related blood stream infection and ventilator-associated pneumonia rates was examined. RESULTS: Over 2 years, 2,472 patients were admitted to the SICU. Mean (SD) age was 42.2 (22.4) years, 79% were male, and 35% had an Injury Severity Score (ISS) of greater than 15. The rate of compliance with head-of-bed elevation significantly improved during the study period (p = 0.01 for trend), with an overall compliance of 97%. Both deep venous thrombosis prophylaxis and gastrointestinal bleed prophylaxis compliance remained stable, with overall rates of 98% and 96%, respectively. The use of sedation holidays also remained stable, with an overall compliance rate of 94%. Compared with our previously published data, the compliance rates with preventative measures were stable or significantly improved; the incidence of catheter-related blood stream infections was lower (0.85/1,000 vs. 4.98/1,000 catheter days, p < 0.001); and the incidence of ventilator-associated pneumonia downtrended (1.66/1,000 vs. 8.74/1,000 ventilator days, p = 0.07). CONCLUSION: Two years after implementation of a QRC, sustainable high rates of compliance with clinically relevant preventative measures in a SICU was demonstrated with minimal fading of clinically relevant outcomes. LEVEL OF EVIDENCE: Therapeutic study, level IV.
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Authors | Pedro G R Teixeira, Kenji Inaba, Joseph Dubose, Nicolas Melo, Margarita Bass, Howard Belzberg, Demetrios Demetriades |
Journal | The journal of trauma and acute care surgery
(J Trauma Acute Care Surg)
Vol. 75
Issue 4
Pg. 717-21
(Oct 2013)
ISSN: 2163-0763 [Electronic] United States |
PMID | 24064888
(Publication Type: Journal Article)
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Topics |
- Adult
- Catheter-Related Infections
(epidemiology)
- Checklist
- Critical Care
(methods, organization & administration, standards)
- Female
- Gastrointestinal Hemorrhage
(prevention & control)
- Guideline Adherence
(statistics & numerical data)
- Humans
- Intensive Care Units
(standards, statistics & numerical data)
- Male
- Outcome and Process Assessment, Health Care
(methods)
- Pneumonia, Ventilator-Associated
(epidemiology)
- Prospective Studies
- Quality Improvement
(organization & administration, standards)
- Quality Indicators, Health Care
- Venous Thrombosis
(prevention & control)
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