Feasibility and utility of the use of real time random safety audits in adult ICU patients: a multicentre study
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The two aims of this study were first to analyse the feasibility and utility (to improve the care process) of implementing a new real time random safety tool and second to explore the efficacy of this tool in core hospitals (those participating in tool design) versus non-core hospitals.
This was a prospective study conducted over a period of 4 months in six adult intensive care units (two of which were core hospitals). Safety audits were conducted 3 days per week during the entire study period to determine the efficacy of the 37 safety measures (grouped into ten blocks). In each audit, 50 % of patients and 50 % of measures were randomized. Feasibility was calculated as the proportion of audits completed over those scheduled and time spent, and utility was defined as the changes in the care process resulting from tool application.
A total of 1323 patient-days were analysed. In terms of feasibility, 87.6 % of the scheduled audits were completed. The average time spent per audit was 34.5 ± 29 min. Globally, changes in the care process occurred in 5.4 % of the measures analysed. In core hospitals, utility was significantly higher in 16 of the 37 measures, all of which were included in good clinical practice guidelines. Most of the clinical changes brought about by the tool occurred in the mechanical ventilation and haemodynamics blocks. Multivariate analyses demonstrated that changes in the care process in each block were associated with the core hospital variable, staffing ratios and severity of patient disease.
Real time safety audits improved the care process and adherence to the clinical practice guidelines and proved to be most useful in situations of high care load and in patients with more severe disease. The effect was greater in core hospitals.
KeywordsSafety Intensive care unit Critical patients Real time safety audits
This study was supported by grants from the Fondo de Investigación Sanitaria (Institute of Health Carlos III from Spain, FIS grants, project PI11/02311). The project is endorsed by the Work Group on Planning, Organization and Management of the Spanish Society of Intensive Medicine and was awarded second prize for the best communication at the National Congress of the Spanish Society of Intensive Medicine, 2014.
- 7.Byrnes MC, Schuerer DJE, Schallom ME, Sona CS, Mazuski JE, Taylor BE, McKenzie W, Thomas JM, Emerson JS, Nemeth JL, Bailey RA, Boyle WA, Buchman TG, Coopersmith CM (2009) Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med 37:2775–2781PubMedCrossRefGoogle Scholar
- 13.Timsit JF, Citerio G, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Hernandez G, Herridge M, Jaber S, Joannidis M, Papazian L, Peters M, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E (2014) Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics. Intensive Care Med 40:471–483PubMedCrossRefGoogle Scholar
- 14.Azoulay E, Citerio G, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Hernandez G, Herridge M, Jaber S, Joannidis M, Papazian L, Peters M, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Timsit JF (2014) Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients. Intensive Care Med 40:305–319PubMedCrossRefGoogle Scholar
- 15.Citerio G, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Hernandez G, Herridge M, Jaber S, Joannidis M, Papazian L, Peters M, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Timsit JF, Azoulay E (2014) Year in review in Intensive Care Medicine 2013: I. Acute kidney injury, ultrasound, hemodynamics, cardiac arrest, transfusion, neurocritical care, and nutrition. Intensive Care Med 40:147–159PubMedCrossRefGoogle Scholar
- 17.Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troché G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufr L (2010) Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II. Am J Respir Crit Care Med 181:134–142PubMedCrossRefGoogle Scholar
- 18.Quenot JP, Plantefeve G, Baudel JL, Camilatto I, Bertholet E, Cailliod R, Reignier J, Rigaud JP (2010) Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: a prospective, multi-centre, observational study. Crit Care 14:R37PubMedCentralPubMedCrossRefGoogle Scholar
- 20.Kash BA, Spaulding A, Johnson CE, Gamm L (2014) Success factors for strategic change initiatives: a qualitative study of healthcare administrator´perspectives. J Health Manag 59:65–81Google Scholar
- 35.Weiss CH, Moazed F, McEvoy CA, Singer BD, Szleifer I, Amaral LA, Kwasny M, Watts CM, Persell SD, Baker DW, Sznajder JI, Wunderink RG (2011) Prompting physician to address a daily checklist and process of care and clinical outcomes. Am J Respir Crit Care Med 184:680–686PubMedCentralPubMedCrossRefGoogle Scholar