title: Organisational characteristics associated with the use of daily interruption of sedation in US hospitals: a national study.
abstract: OBJECTIVE
  Daily interruption of sedation (DIS) has multiple proven benefits, but implementation is erratic. Past research on sedative interruption utilisation focused on individual clinicians, ignoring the role of organisations in shaping practice. The authors test the hypothesis that specific hospital organisational characteristics are associated with routine use of DIS.
  
  
  METHODS
  National, mailed survey to a stratified random sample of US hospitals in 2009. Respondents were the lead infection control professionals at each institution.
  
  
  METHODS
  Survey items enquired about DIS use, institutional structure, and organisational culture. Multivariable analysis was used to evaluate the independent association of these factors with DIS use.
  
  
  RESULTS
  A total of 386 hospitals formed our final analytic sample; the response rate was 69.4%. Hospitals ranged in size from 25 to 1359 beds. 26% of hospitals were associated with a medical school. Almost 80% reported regular use of DIS for ventilated patients. While 75.4% of hospitals reported having leadership focus on safety culture, only 42.7% reported that their staff were receptive to changes in practice. In a multivariable logistic regression model, structural characteristics such as size and academic affiliation were not associated with use of DIS. However, leadership emphasis on safety culture (p=0.04), staff receptivity to change (p=0.02) and involvement in an infection prevention collaborative (p=0.04) were significantly associated with regular DIS use.
  
  
  CONCLUSIONS
  Several elements of hospital organisational culture were associated with regular use of DIS in US hospitals. These findings emphasise the importance of combining specific administrative approaches with strategies to encourage receptivity to change among bedside clinicians in order to successfully implement complex evidence-based practices in the intensive care setting.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. melmille@umich.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Miller
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D019538:Health Care Surveys; D006739:Hospital Administration; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D015999:Multivariate Analysis; D015279:Organizational Culture; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000379:methods*; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives