title: Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit.
abstract: OBJECTIVE
  Need for improved sedation strategy for adults receiving ventilator support.
  
  
  METHODS
  Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative.
  
  
  METHODS
  A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (>18 years) treated by intermittent positive pressure ventilation for more than 24 hours.
  
  
  METHODS
  Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes.
  
  
  METHODS
  Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial.
  
  
  RESULTS
  Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (-0.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified.
  
  
  CONCLUSIONS
  Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway. gbra@hele-bergen.no
authors.forename: G
authors.initials: G
authors.lastname: Brattebø
authors.forename: D
authors.initials: D
authors.lastname: Hofoss
authors.forename: H
authors.initials: H
authors.lastname: Flaatten
authors.forename: A K
authors.initials: AK
authors.lastname: Muri
authors.forename: S
authors.initials: S
authors.lastname: Gjerde
authors.forename: P E
authors.initials: PE
authors.lastname: Plsek
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D004363:Drug Utilization / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units / Q000592:standards*; D007385:Intermittent Positive-Pressure Ventilation / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D009664:Norway; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods
chemical_list: D006993:Hypnotics and Sedatives