NDLI: Association between hospital volume and network membership and an analgesia, sedation and delirium order set quality score: a cohort study

Content Provider	Springer Nature : BioMed Central
Author	Dale, Christopher R Hayden, Shailaja J Treggiari, Miriam M Curtis, J Randall Seymour, Christopher W Yanez, N David Fan, Vincent S
Abstract	Introduction Protocols for the delivery of analgesia, sedation and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniformly used. The extent to which elements of analgesia, sedation and delirium guidelines are incorporated into order sets at hospitals across a geographic area is not known. We hypothesized that both greater hospital volume and membership in a hospital network are associated with greater adherence of order sets to sedation guidelines. Methods Sedation order sets from all nonfederal hospitals without pediatric designation in Washington State that provided ongoing care to mechanically ventilated patients were collected and their content systematically abstracted. Hospital data were collected from Washington State sources and interviews with ICU leadership in each hospital. An expert-validated score of order set quality was created based on the 2002 four-society guidelines. Clustered multivariable linear regression was used to assess the relationship between hospital characteristics and the order set quality score. Results Fifty-one Washington State hospitals met the inclusion criteria and all provided order sets. Based on expert consensus, 21 elements were included in the analgesia, sedation and delirium order set quality score. Each element was equally weighted and contributed one point to the score. Hospital order set quality scores ranged from 0 to 19 (median = 8, interquartile range 6 to 14). In multivariable analysis, a greater number of acute care days (P = 0.01) and membership in a larger hospital network (P = 0.01) were independently associated with a greater quality score. Conclusions Hospital volume and membership in a larger hospital network were independently associated with a higher quality score for ICU analgesia, sedation and delirium order sets. Further research is needed to determine whether greater order-set quality is associated with improved outcomes in the critically ill. The development of critical care networks might be one strategy to improve order set quality scores.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc11390.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc11390
Journal	Critical Care
Issue Number	3
Volume Number	16
Language	English
Publisher	BioMed Central
Publisher Date	2012-06-18
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Quality Score Knowledge Translation Hospital Volume Spontaneous Breathing Trial Hospital Network
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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