Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists
Autor: | Andre Carlos Kajdacsy-Balla Amaral, Niall D. Ferguson, Ruxandra Pinto, Gordon D. Rubenfeld, Jan O. Friedrich, Federico Angriman |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male Patient Transfer medicine.medical_specialty Critical Illness Critical Care and Intensive Care Medicine Odds 03 medical and health sciences 0302 clinical medicine Intensive care Health care Humans Medicine Aged Quality Indicators Health Care Academic Medical Centers business.industry 030208 emergency & critical care medicine Odds ratio Middle Aged Respiration Artificial Anti-Bacterial Agents Discontinuation Intensive Care Units 030228 respiratory system Practice Guidelines as Topic Cohort Emergency medicine Airway Extubation Female Observational study Guideline Adherence Neuromuscular Blocking Agents business Ventilator Weaning Cohort study |
Zdroj: | Critical Care Medicine. 48:e227-e232 |
ISSN: | 0090-3493 |
DOI: | 10.1097/ccm.0000000000004201 |
Popis: | Objectives We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care. Design Cohort study using data from the Toronto Intensive Care Observational Registry. Setting Seven academic ICUs in Toronto, Ontario. Patients Critically ill mechanically ventilated adult patients. Interventions We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents). Two practices that are less guided by evidence (early discontinuation of antibiotics and extubation attempts) served as positive controls. We conducted the analysis using generalized estimating equations to account for clustering at the patient level. Measurements and main results The cohort consisted of 10,570 patients admitted between June 2014 and August 2018. Compliance varied for each practice (63.6%, 42.5%, and 21.1% for lung-protective ventilation, spontaneous breathing trials, and neuromuscular blockade, respectively). There was no effect of transitions of care on compliance with spontaneous breathing trials (odds ratio, 1.00; 95% CI, 0.95-1.07), lung-protective ventilation (odds ratio, 1.07, 95% CI, 0.90-1.26), or neuromuscular blockade use (odds ratio, 0.95; 95% CI, 0.75-1.20). However, early antibiotic discontinuation was more likely (odds ratio, 1.23; 95% CI, 1.06-1.42) and extubation attempts were less frequent (odds ratio, 0.77; 95% CI, 0.65-0.93) after a transition of care. Conclusions We observed no significant impact of transitions of care between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood of extubation and higher odds of earlier discontinuation of antibiotics. |
Databáze: | OpenAIRE |
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