title: Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs.
abstract: OBJECTIVE
  Use of sedation protocols is associated with fewer mechanical ventilation days in critically ill patients. Canadian intensive care units (ICUs) often have a higher nurse-patient ratio and more specialised training of ICU nurses than French ICUs. Considering these differences, the purpose of this study was to compare implementation of sedation protocols as indicated by frequency of sedation assessment and response to levels of sedation between a Canadian and a French ICU.
  
  
  METHODS
  This was a retrospective observational study of 30 patients who were mechanically ventilated for at least 24 h in each of two tertiary care ICUs in Vancouver, Canada and Montpellier, France. The authors tabulated all Richmond Agitation-Sedation Scale scores, frequency of score measurement, target scores, frequency and magnitude of scores that were out of target range, and the response to these scores within 1 h of measurement. Practices between the two hospitals were compared using regression modelling, adjusting for patient age, sex, and Acute Physiology and Chronic Health Evaluation (APACHE) II score.
  
  
  RESULTS
  Although sedation scores were measured more frequently in the Canadian ICU, there were fewer appropriate adjustments in medications in response to scores that were outside the target range in this ICU than in the French ICU, which had a lower nurse-patient ratio and no specialised training of nurses (OR 0.26 (95% CI 0.13 to 0.50) for scores that were higher than target, and OR 0.14 (95% CI 0.07 to 0.28) for scores that were lower than target).
  
  
  CONCLUSIONS
  Differences in sedation management between these ICUs are likely related to factors other than nurse-patient ratio or specialised training of ICU nurses.
authors.affiliation: Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada. pedodek@interchange.ubc.ca
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Glen
authors.initials: G
authors.lastname: Brown
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.forename: Maja
authors.initials: M
authors.lastname: Grubisic
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D018806:APACHE; D000368:Aged; D002170:Canada; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D015279:Organizational Culture; D010347:Patient Care Planning; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000078329:Workforce