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Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study

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Abstract

Objective

To assess adherence to clinical practice guidelines for three interventions routinely used in critical care medicine.

Design and setting

Multicenter, 1-day cross-sectional observational study in 44 intensive care units in four countries.

Patients

A total of 419 patients hospitalized in participating ICUs on the day of the survey.

Measurements and results

Red blood cell transfusion (n = 29) was performed appropriately in 22 patients (76%), while among the 390 patients who received no transfusion 4 (1%) had a valid indication. Setting of tidal volume in acute respiratory distress syndrome, assessed in 45 patients, was deemed appropriate in 37 cases (82%). Prescription of stress ulcer prophylaxis (n = 128) was appropriate in only 24 patients (19%), while among the 268 patients who were not treated 28 (10%) had an indication.

Conclusions

The implementation of recommendations varies across different domains of care. While the adherence to current recommendations in routine practice is acceptable as regards tidal volume settings in acute respiratory distress syndrome, it is suboptimal for blood transfusion and prevention of upper gastrointestinal bleeding. Practice surveys are useful to inform strategies currently developed to assess practices of health-care professionals and develop strategies for more effective dissemination of medical knowledge.

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Acknowledgements

TECLA Steering Committee members were: F. Feihl, MD, H. Mentec, MD, D. Annane, MD, PhD, C. Brun-Buisson, MD, PhD, C. Melot, MD, PhD, P. Vignon, MD, PhD. Members of the Epidemiology and Clinical Research Commission (Commission d'Epidemiologie et de Recherche Clinique) were: Hervé Mentec (Argenteuil, France), Djillali Annane (Garches, France), Pascal Beuret (Roanne, France), Julien Bohé (Lyon, France), Bernard Bouffandeau (Elbeuf, France), Fabrice Bruneel (Versailles, France), Christian Brun-Buisson (Créteil, France), Yves Cohen (Bobigny, France), Robin Cremer (Lille, France), François Feihl (Lausanne, Switzerland), Bertrand Guidet (Paris, France), Mercé Jourdain (Lille, France), Jean-Michel Liet (Nantes, France), Christian Melot (Brussels, Belgium), Mehran Monchi (Massy, France), Jean-Charles Preiser (Liege, Belgium), Jean-Pierre Quenot (Dijon, France), Jean-Philippe Rigaud (Dieppe, France), Marie-Denise Schaller (Lausanne, Switzerland), Philippe Vignon (Limoges, France), Christophe Vinsonneau (Paris, France). Participants by country (listed alphabetically) were: France: C. Galland, Saint-Omer Hospital; C. Brun-Buisson, Henri Mondor Hospital, Créteil, E. Maury, Saint-Antoine Hospital, Paris; M. Jourdain, R. Salengro Hospital, Lille; P. Beuret Roanne Hospital; S. Moulront, Dunkerque Hospital; N. Milesi-Defrance, General Hospital, Dijon; I. Coquet and J.P. Quenot, Bocage Hospital, Dijon; E. Boulet R. Dubos Hospital, Pontoise; L. Holzapfel Fleyriat Hospital, Bourg en Bresse; D. Annane, Raymond Poincaré Hospital, Garches; S. Jamali, Dourdan Hospital; H. Mentec, Victor Dupouy Hospital, Argenteuil; M. Monchi, J. Cartier Institut, Massy Palaiseau; D. Goldran-Toledano, Sainte Justine Hospital, Gonesse; P. Vignon, Dupuytren Hospital, Limoges; M. Fartoukh, Tenon Hospital, Paris; J.C. Farkas, Saint André Polyclinic; J.P. Rigaud, Dieppe Hospital; J.L. Ricome Poissy Hospital, St Germain en Laye; C. Broux, Michalon Hospital, Grenoble; A. Mercat, Angers Hospital; J. Bohé Lyon Sud Hospital; P.E. Bollaert, Central Hospital, Nancy; D. Villers, Hotel Dieu Hospital, Nantes; A. Combes, Pitié Salpêtrière Hospital, Paris; B. Raynard, G. Roussy Institut, Villejuif; D. Dubois, Arras Hospital; J.F. Loriferne, St. Camille Hospital, Bry sur Marne; Richard C. Bicêtre Hospital; I. Mohammedi, E. Herriot Hospital, Lyon; T. Boulain, Orléans Hospital; P. Tourneux, Amiens Hospital; A. Lepape, Lyon Sud Hospital, Lyon, Switzerland: C. Vannay-Boubiche, Lausanne Hospital; F. Feihl, Lausanne Hospital; MD Schaller Lausanne Hospital Canada: P. Jouvet, Sainte Justine Hospital, Montreal, Quebec. Belgium: V. Fraipont, Citadelle Hospital, Liege; C. Mélot, Erasm Hospital, Brussels. The TECLA Study Group is indebted to the Société de Réanimation de Langue Française, the company SCDMI (www.scdmi.com) and to the Polytechnic School of the Free University of Brussels. We gratefully thank all the participating members of the study. We thank Fiona Ecarnot for editorial assistance.

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Correspondence to Jean-Pierre Quenot.

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The full list of investigators participating in the TECLA study appears under Acknowledgements.

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Quenot, JP., Mentec, H., Feihl, F. et al. Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study. Intensive Care Med 34, 1393–1400 (2008). https://doi.org/10.1007/s00134-008-1059-y

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