The effect of a managerial-based intervention on the occurrence of out-of-range-measurements and mortality in intensive care units.
OBJECTIVE
To evaluate the effect of an organization-based managerial intervention on performance of intensive care units (ICUs).


METHODS
Prospective multicentre cluster-randomized study with an intervention at the level of ICU staff was carried out. The intervention comprised a set of managerial changes, concerning the nurses' level of skill discretion and participation in decision-making introduced during a period of six months. The ICU-performance was monitored before, during and after the intervention, in terms of mortality and occurrence of out-of-range-measurements (ORMs). The ORMs were defined as a derangement of systolic blood pressure (BP), heart rate (HR), oxygen saturation (SaO2) and urine output (Diur). Data were statistically analyzed by logistic regression with random effects due to ICUs.


RESULTS
The overall ICU and hospital mortalities were 14% and 20%, the incidence of BP, HR, O2 and Diur ORM was respectively 46%, 38%, 28% and 48%. After adjusting for SAPSII, admission type and age the regression analyses revealed a positive effect of the intervention for all the six outcome variables.


CONCLUSIONS
The intervention reduced both the ICU and hospital mortalities and the incidences of the out-of-range measurements. Registering ORMs provides a feasible method for evaluating ICU performance and could help to optimize individual patient care.
Faculty of Medical Sciences, University of Groningen, The Netherlands. V.FIDLER@MED.RUG.NL
Vaclav
V
Fidler
Raoul
R
Nap
Dinis Reis
DR
Miranda
D000328:Adult; D001794:Blood Pressure; D016000:Cluster Analysis; D003657:Decision Making; D005060:Europe; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D015337:Multicenter Studies as Topic; D024802:Nurse's Role; D010101:Oxygen Consumption; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D016896:Treatment Outcome