title: Creating a culture of clinical excellence in critical care nutrition: the 2008 "Best of the Best" award.
abstract: OBJECTIVE
  To develop, validate, and implement a system to reward top performers in critical care nutrition practice and to illuminate characteristics of top-performing intensive care units (ICUs).
  
  
  METHODS
  An international, prospective, observational, cohort study conducted in May 2008.
  
  
  METHODS
  179 ICUs from 18 countries.
  
  
  METHODS
  2956 consecutively enrolled mechanically ventilated adult patients who stayed in the ICU for at least 72 hours.
  
  
  METHODS
  To qualify for the "Best of the Best" (BOB) award, sites had to have implemented a nutrition protocol and contributed complete data on a minimum of 20 patients.
  
  
  RESULTS
  Data on nutrition practices were collected from ICU admission to ICU discharge for a maximum of 12 days. Eligible sites were ranked based on their performance on the following 5 criteria: adequacy of provision of energy, use of enteral nutrition (EN), early initiation of EN, use of promotility drugs and small bowel feeding tubes, and adequate glycemic control. Of the 179 participating ICUs, 81 qualified for the BOB award. Overall, the average nutrition adequacy across sites was 56.2% (site range, 20.3%-90.1%). The top 10 performers were identified and publicly recognized. Regression analysis suggested that the presence of a dietitian in the ICU was associated with a high BOB award ranking, whereas being located in the United States or China, relative to other participating countries, was associated with worst performance.
  
  
  CONCLUSIONS
  There is variable performance with respect to critical care nutrition practices across the world.
authors.affiliation: Department of Medicine, Queen's University, Kingston, ON, Canada. dkh2@queensu.ca
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Richard D
authors.initials: RD
authors.lastname: Heyland
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.forename: Xuran
authors.initials: X
authors.lastname: Jiang
authors.forename: Siouxzy
authors.initials: S
authors.lastname: Morrison
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
mesh_terms: D000328:Adult; D001363:Awards and Prizes; D002681:China; D002985:Clinical Protocols / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007902:Length of Stay; D044623:Nutrition Therapy / Q000592:standards*; D019370:Observation; D011364:Professional Practice / Q000592:standards*; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial; D014481:United States