Improving care for the ventilated patient.
BACKGROUND
Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis.


METHODS
The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes, (2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies.


RESULTS
Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4-April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001).


CONCLUSIONS
Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.
Berenholtz
Sean M
SM
Departments of Anesthesiology/Critical Care Medicine, Surgery, and Health Policy & Management, Johns Hopkins University, Baltimore, USA. sberenho@jhmi.edu
Milanovich
Shelley
S
Faircloth
Amanda
A
Prow
Donna T
DT
Earsing
Karen
K
Lipsett
Pamela
P
Dorman
Todd
T
Pronovost
Peter J
PJ
D015142:Baltimore; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D012121:Respiration, Artificial / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States