title: A greater analgesia, sedation, delirium order set quality score is associated with a decreased duration of mechanical ventilation in cardiovascular surgery patients.
abstract: OBJECTIVE
  Protocols and order sets for the delivery of analgesia, sedation, and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniform in hospitals across geographic areas. The extent to which greater order set quality is associated with improved patient outcomes is not known. We hypothesized that cardiac surgery patients cared for at hospitals with a greater analgesia, sedation, and delirium order set quality score (more guideline-concordant order sets) would have a shorter average duration of mechanical ventilation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All Washington State non-federal hospitals providing cardiac surgery.
  
  
  METHODS
  All mechanically ventilated cardiac surgery patients from January 1, 2008, until September 30, 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  We created a multivariable linear regression model to assess the relationship between a hospital's pain, agitation and delirium order set quality, as assessed by an expert-validated order set quality score, and the average duration of mechanical ventilation of its cardiac surgery patients, independent of other hospital and patient factors. A total of 19,561 patients underwent cardiac surgery at 16 Washington state hospitals during the study period. The order set quality scores ranged from 4 to 19 with a mean of 11.8 ± 4.5. The mean duration of mechanical ventilation was 27.0 ± 196.6 hours. In the multivariable model, independent of other patient and hospital factors, a 1-point increase in the order set quality score was associated with a 3.3 ± 0.9 hour (p < 0.01) decrease in average duration of mechanical ventilation.
  
  
  CONCLUSIONS
  Cardiac surgery hospitals with more guideline-adherent analgesia, sedation, and delirium order sets have patients with shorter mean durations of mechanical ventilation than hospitals with lower order set quality scores.
authors.affiliation: 1Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 2Department of Health Services, University of Washington, Seattle, WA. 3Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, WA. 4Department of Biostatistics, University of Washington, Seattle, WA. 5Department of Anesthesiology, University of Washington, Seattle, WA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Dale
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: N David
authors.initials: ND
authors.lastname: Yanez
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Treggiari
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods; D013504:Cardiovascular Surgical Procedures; D002985:Clinical Protocols; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards*; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives