The Association of ICU Acuity With Adherence to ICU Evidence-Based Processes of Care
AuthorVranas, Kelly C
Scott, Jennifer Y
Harhay, Michael O
Slatore, Christopher G
Sullivan, Donald R
Kerlin, Meeta Prasad
MetadataShow full item record
AbstractBackground: 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.
Rights/TermsCopyright © 2020. Published by Elsevier Inc.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/13465
- The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying.
- Authors: Vranas KC, Jopling JK, Scott JY, Badawi O, Harhay MO, Slatore CG, Ramsey MC, Breslow MJ, Milstein AS, Kerlin MP
- Issue date: 2018 Mar
- Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes.
- Authors: Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, Chandler MW, Irwin RS, University of Massachusetts Memorial Critical Care Operations Group.
- Issue date: 2011 Jun 1
- Venous Thromboembolism Prophylaxis in Neurocritical Care Patients: Are Current Practices, Best Practices?
- Authors: Sauro KM, Soo A, Kramer A, Couillard P, Kromm J, Zygun D, Niven DJ, Bagshaw SM, Stelfox HT
- Issue date: 2019 Apr
- Effect of published scientific evidence on glycemic control in adult intensive care units.
- Authors: Niven DJ, Rubenfeld GD, Kramer AA, Stelfox HT
- Issue date: 2015 May
- Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial.
- Authors: Doig GS, Simpson F, Finfer S, Delaney A, Davies AR, Mitchell I, Dobb G, Nutrition Guidelines Investigators of the ANZICS Clinical Trials Group.
- Issue date: 2008 Dec 17