The availability of clinical protocols in US teaching intensive care units.
OBJECTIVE
Clinical protocols to standardize care may improve patient outcomes but worsen trainee education. Our objective was to determine the availability of clinical protocols in teaching medical intensive care units (ICUs).


METHODS
We administered an electronic questionnaire regarding protocol availability in 5 specific clinical areas. All directors of adult medical ICUs in US teaching hospitals were eligible to participate.


RESULTS
The response rate was 70%. Eighty-six percent of ICU directors reported availability of protocols for ventilation liberation, 73% for sedation, 62% for sepsis resuscitation, 60% for lung-protective ventilation, and 48% for life support withdrawal. Ventilation liberation protocols are most often started and driven by respiratory therapists (40% and 90%); sedation started by residents (41%) and driven by nurses (95%); sepsis resuscitation started and driven by residents (49% and 46%); lung-protective ventilation started by attending physicians (39%) and driven by respiratory therapists (67%); and life support withdrawal started by attending physicians (93%) and driven by nurses (47%).


CONCLUSIONS
There is wide variation in clinical protocol availability among teaching hospitals. Further study of the effect of protocols on education is needed.
Prasad
Meeta
M
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. meeta.prasad@uphs.upenn.edu
Christie
Jason D
JD
Bellamy
Scarlett L
SL
Rubenfeld
Gordon D
GD
Kahn
Jeremy M
JM
D002983:Clinical Competence; D002985:Clinical Protocols; D003422:Critical Care / Q000592:standards*; D004501:Education, Medical; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014481:United States
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