Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit.
OBJECTIVE
In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU).


METHODS
A 51-day baseline audit period (Phase I) in a 20-bed (private rooms) surgical ICU was compared with a 34-day period in the same unit after implementation of the guidelines (Phase II).


METHODS
Phase I included 182 patients (670 patient days), and Phase II included 139 patients (427 patient days).


RESULTS
There was no significant difference between patients in the Phase I and Phase II groups regarding age (65.4/19-95 vs. 64.8/18-90 yrs), gender (56% male vs. 55% male), severity of illness (mean Acute Physiology and Chronic Health Evaluation III, 38 vs. 39.1), total infections (respiratory, 8% vs. 4%; urinary tract, 15% vs. 4%; wound, 4% vs. 3%; skin/soft tissue, 3% vs. 7%; sepsis, 5% vs. 3%; intra-abdominal, 9% vs. 17%), and no infection (64% vs. 67%). Clinical outcomes of patients with infections in the Phase I group compared with those in the Phase II group were as follows: clinical improvement or cure, 64% vs. 76%; persistent infection, 17% vs. 11%; clinical failure, 0 vs. 2%; and death, 18% vs. 7% (p = NS). When patients with infections were compared, death rates were 20% in the Phase I group and 5.6% in the Phase II group (p = .02). After implementation of the clinical pathways, antibiotic costs were reduced from $676.54 per patient to $157.88 per patient (p = .001). Length of stay in the ICU was 3.7 days in the Phase I trial and a mean of 3 days in the Phase II trial (p = NS). Specimens of Escherichia coli demonstrated a trend toward a decreased resistance to all antibiotics and Pseudomonas aeruginosa to ciprofloxacin and aminoglycosides (p = NS).


CONCLUSIONS
In this study, the use of clinical practice guidelines for patients who were admitted to the surgical ICU was shown to reduce costs, without adversely affecting patients' outcomes. This study has important implications for the use of clinical practice guidelines for the management of patients with infections who are admitted to surgical ICUs.
Price
J
J
Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
Ekleberry
A
A
Grover
A
A
Melendy
S
S
Baddam
K
K
McMahon
J
J
Villalba
M
M
Johnson
M
M
Zervos
M J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D003422:Critical Care / Q000191:economics / Q000592:standards; D003428:Cross Infection / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006764:Hospitals, Community / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010346:Patient Care Management / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents