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Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit.
Journal of Trauma and Acute Care Surgery 2013 October
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.
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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