A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care

Implementation Science

Peter H. J. van der Voort³  Gert P. Westert⁷  Kitty J. Jager⁴  Nicolette F. de Keizer⁴  Niels Peek¹  Wilco C. Graafmans²  Bram Wouterse⁵  Sabine N. van der Veer⁴  Maartje L. G. de Vos⁶ 

[1] Health e-Research Centre, The University of Manchester, Manchester, UK;Health Strategy and Health Systems Unit, European Commission, Brussels, Belgium;TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands;Department of Medical Informatics, Academic Medical Center, Amsterdam, 1100 DD, The Netherlands;Center for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, 3720 BA, The Netherlands;Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, 3720 BA, The Netherlands;Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

关键词: Nurse-to-patient ratio;    Bed occupancy;    Quality improvement;    Critical care;    Multifaceted feedback;   

Others  :  1219010
DOI  :  10.1186/s13012-015-0285-2

 received in 2014-11-27, accepted in 2015-06-30,  发布年份 2015

【 摘 要 】

Background

Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.

Methods

In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.

Results

We analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 % CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41–1.26 compared to baseline and OR 0.65; 95 % CI 0.35–1.19 compared to control group).

Conclusions

A multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.

Trial registration

ISRCTN: ISRCTN50542146

【 授权许可】

   
2015 de Vos et al.

【 图 表 】

Fig. 1.

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