ICUs get quality improvement intervention

A quality improvement intervention that included education, reminders and feedback through a telecommunication network improved the adoption of evidence-based care practices in intensive care units at community hospitals.

"Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them," says Dr. Damon Scales, lead investigator on the study and intensivist at Sunnybrook.

"Nonacademic hospitals face larger barriers to implementing evidence-based care because of heavier individual clinician workloads and few personnel devoted to collaborative continuing educational activities."

The six 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)
• 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.

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," Scales adds.

The study will appear in the January 26 issue of JAMA.