The Association of ICU Acuity With Adherence to ICU Evidence-Based Processes of Care

被引:6
作者
Vranas, Kelly C. [1 ,2 ,7 ]
Scott, Jennifer Y. [2 ]
Badawi, Omar [3 ,4 ,5 ]
Harhay, Michael O. [6 ,7 ]
Slatore, Christopher G. [1 ,2 ]
Sullivan, Donald R. [1 ,2 ]
Kerlin, Meeta Prasad [7 ,8 ]
机构
[1] Oregon Hlth & Sci Univ, Div Pulm & Crit Care, Portland, OR 97201 USA
[2] VA Portland Hlth Care Syst, Hlth Serv Res & Dev, Portland, OR USA
[3] Philips Healthcare, Dept Res & Dev, Baltimore, MD USA
[4] Univ Maryland, Sch Pharm, Dept Pharm Practice & Sci, Baltimore, MD 21201 USA
[5] MIT, Inst Med Engn & Sci, 77 Massachusetts Ave, Cambridge, MA 02139 USA
[6] Univ Penn, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA
[7] Univ Penn, Palliat & Adv Illness Res PAIR Ctr, Philadelphia, PA 19104 USA
[8] Univ Penn, Pulm Allergy & Crit Care Div, Philadelphia, PA 19104 USA
关键词
critical care; evidence-based medicine; guidelines; ICU; patient safety; CRITICALLY-ILL PATIENTS; HOSPITAL VOLUME; STRESS HYPERGLYCEMIA; HEALTH-CARE; MORTALITY; UNIT; MULTICENTER; RISK; PERFORMANCE; OUTCOMES;
D O I
10.1016/j.chest.2020.02.061
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: Admission to high-acuity ICUs has been associated with improved outcomes compared with outcomes in low-acuity ICUs, although the mechanism for these findings is unclear. RESEARCH QUESTION: The goal of this study was to determine if high-acuity ICUs more effectively implement evidence-based processes of care that have been associated with improved clinical outcomes. STUDY DESIGN AND METHODS: This retrospective cohort study was performed in adult ICU patients admitted to 322 ICUs in 199 hospitals in the Philips ICU telemedicine database between 2010 and 2015. The primary exposure was ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles. Multivariable logistic regression was used to examine relations of ICU acuity with adherence to evidence-based VTE and stress ulcer prophylaxis, and with the avoidance of potentially harmful events. These events included hypoglycemia, sustained hyperglycemia, and liberal transfusion practices (defined as RBC transfusions prescribed for nonbleeding patients with preceding hemoglobin levels >= 7 g/dL). RESULTS: Among 1,058,510 ICU admissions, adherence to VTE and stress ulcer prophylaxis was high across acuity levels. In adjusted analyses, those admitted to low-acuity ICUs compared with the highest acuity ICUs were more likely to experience hypoglycemic events (adjusted OR [aOR], 1.12; 95% CI, 1.04-1.19), sustained hyperglycemia (aOR, 1.07; 95% CI, 1.04-1.10), and liberal transfusion practices (aOR, 1.55; 95% CI, 1.33-1.82). INTERPRETATION: High-acuity ICUs were associated with better adherence to several evidence-based practices, which may be a marker of high-quality care. Future research should investigate how high-acuity ICUs approach ICU organization to identify targets for improving the quality of critical care across all ICU acuity levels.
引用
收藏
页码:579 / 587
页数:9
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