Actually Using What We Know

Intervention in ICUs increases adoption of evidence-based care practices

(RxWiki News) A recent study found that the health care system is failing to apply the most current research-based evidence to make decisions about patient care. Now, a new study has identified a way to increase use of evidence-based care in ICUs.

Evidence-based care practices are those practices recommended as a result of solid research and evaluation.

Compared to research hospitals, non-academic hospitals have more trouble applying evidence-based care practices because of demanding clinician workloads and a shortage of employees dedicated to sustaining collaborative educational practices. This results in an estimated 55 percent of adult patients not receiving the most up-to-date care that is recommended based on research. Approximately 66 percent of stroke patients, and only 40 percent of osteoporosis patients receive evidence-based treatment.

Damon C. Scales, M.D., Ph.D., of the University of Toronto and Sunnybrook Health Sciences Center, and colleagues found that an improvement intervention involving education, reminders, and feedback increased the use of evidence-based care in intensive care units (ICUs).

The researchers studied six evidence-based ICU care practices in 15 ICUs of community hospitals in Canada. The six practices that were analyzed were: prevention of ventilator-associated pneumonia (VAP); prevention of deep vein thrombosis (DVT); sterile precautions for central venous catheter insertion in order to avoid infections; daily spontaneous breathing trials to reduce the amount of time a patient spends on aided breathing mechanisms; starting feeding tube early; and a daily evaluation of a patient's risk of developing pressure ulcers.

For the study, researchers separated the ICUs into two groups. Each group received one targeted care practice every four months, while also serving as a control to the other group, which was undergoing the implementation of a different care practice. The ICUs that were undergoing intervention participated in videoconference forums that evaluated clinicians in addition to providing educational sessions, feedback, and reminders.

Dr. Scales and colleagues found that patients were more likely to receive evidence-based care if they were in ICUs undergoing intervention than if they were in control ICUs. Over the course of the entire study, in ICUs receiving intervention, ventilator-associated pneumonia decreased by 40 percent (from a prevalence of 50 percent to 90 percent) just from positioning patients in a semi-sitting-up position. The number of patients receiving the recommended treatment for prevention of catheter-related bloodstream infection increased from 10.6 percent to 70 percent.

The rate of adoption of other practices was much smaller. However, many of those practices already had high rates of adherence at the onset of the study.

Although the interventions increased the adoption of evidence-based care practices, the quality of those practices was not consistent across different ICUs. According to the study's authors, future attempts to improve performance of recommended care should take into account measured care gaps (as opposed to reported care gaps) and the particular needs of specific hospitals. Additionally, future interventions should involve evaluations of ICUs that perform badly.

The study is published in the January 26 issue of JAMA.

Review Date: 
January 24, 2011