Health & Medical intensive care

Quality in the Intensive Care Unit

´╗┐Quality in the Intensive Care Unit

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units: A Cluster Randomized Trial

Scales DC, Dainty K, Hales B, et al.
JAMA. 2011;305:363-372

Study Summary

Although we use numerous and expensive life-sustaining technologies in the intensive care unit (ICU), it is unlikely that any given ICU is delivering care at the highest level of which it is capable. This is particularly true given variations in care models, institutional case mix, and the evolving nature of clinical evidence. Scales and coworkers sought to determine the effectiveness of a quality improvement program for increasing delivery of 6 evidence-based practices in the ICU using a cluster-randomized trial in Ontario involving a total of 9269 admissions during the intervention and 7141 admissions during a subsequent monitoring period. The intervention included audit and feedback, expert-led educational sessions, and algorithm dissemination. The results showed that practices changed more in intervention ICUs (odds ratio 2.79), with the greatest effect for semirecumbent positioning to prevent ventilator-associated pneumonia and prevention methods for catheter-related bloodstream infection, whereas adoption of other practices changed little. The investigators concluded that a multifaceted quality improvement intervention improved adoption of care practices in a collaborative network of community ICUs.


This study shows that a multifaceted quality improvement program can effectively improve the delivery of evidence-based care practices in ICUs. This is particularly important given increasing focus by the federal government and other healthcare funding agencies to monitor and drive performance improvement. Although the improvements were not universal and not all practices were affected uniformly, the changes clearly influenced important areas where evidence could improve the delivery of ICU care. Perhaps of greater importance, the study shows the potential to successfully conduct a quality improvement project involving multiple stakeholders and across numerous institutions, including in community hospitals, rather than only in academic institutions. Whether the optimal method is linking ICUs by video conferencing and telecommunication infrastructure remains to be determined, and future efforts must consider how to identify the best areas for improvement activities, local and regional needs, and even whether resources should be provided to poorly performing ICUs if they represent the greatest potential for improvement.


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