A Simple Widespread Computer Help Improves Nutrition Support Orders and Decreases Infection Complications in Critically Ill Patients

Conseil, Mathieu; Carr, Julie; Molinari, Nicolas; Coisel, Yannaël; Cissé, Moussa; Belafia, Fouad; Delay, J; Jung, Boris; Jaber, Samir; Chanques, Gérald

doi:10.1371/journal.pone.0063771

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…(6) A recent French study of ICU patients utilized a computerized system to support decision making regarding the achievement of nutrition goals. (7) They showed that compared to historical controls, more patients in the computer-assisted group achieved 80% of the nutrition goals for both calories (79% versus 45%, p < 0.001) and nitrogen (37% versus 3%, p < 0.001). In addition, the incidence of nosocomial infections decreased from 59% to 41%, p < 0.03) in the computer-assisted group.…”

Section: How Much To Prescribe?mentioning

confidence: 97%

How could we make nutrition in the intensive care unit simple?

Singer

Cohen

2016

Revista Brasileira De Terapia Intensiva

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Section: How Much To Prescribe?mentioning

confidence: 97%

How could we make nutrition in the intensive care unit simple?

Singer

Cohen

2016

Revista Brasileira De Terapia Intensiva

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“…Despite the increasing recognition of nutrition status as a modifiable risk factor for life-threatening complications, the importance of nutrition care seems often overlooked by physicians because of a lack of specific interest and training in medical nutrition and/or by the complexity of prescriptions requiring several calculations. 1 As a result, there is a lack of standardization and an extensive heterogeneity in the prescription of nutrition. Moreover, the application of nutrition therapy is also widely variable in terms of proportion of prescribed amount of nutrition formulas, time to reach the target, and reasons for interruptions.…”

mentioning

confidence: 99%

Computer‐Assisted Prescription: The Future of Nutrition Care?

Preiser

Laureys

Zanten

et al. 2020

J Parenter Enteral Nutr

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“…In practice, they are not''. Quality improvement programs have been used for implementation of protocols of intubation [4,5], sedation analgesia [6], support for families [7,8], prevention of nosocomial infections [9,10], or nutrition [11]. The importance of sharing its accomplishments through the published literature increases [3], particularly in the ICU setting.…”

mentioning

confidence: 99%

From weaning theory to practice: implementation of a quality improvement program in ICU

Jong

Jaber

2015

Intensive Care Med

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In their recent article in Intensive Care Medicine, Bo et al. [1] report the effect on clinical outcomes of implementing a comprehensive quality improvement (QI) program aiming to improve the compliance with protocol-directed weaning. The authors performed a beforeafter cluster randomized trial in 14 China intensive care units (ICUs), enrolling 884 patients. In the non-QI group, 444 patients (193 for the baseline, 251 for the QI phase) and in the QI group 440 patients (199 for the baseline, 241 for the QI phase) were included. The protocol-directed weaning in the QI group was associated with significant decreases of median duration of mechanical ventilation [from 7 days in the non-QI group to 3 days in the QI group (p = 0.003)] and median lengths of ICU stay [from 10 to 6 days (p = 0.004)] and hospital stay [from 23 to 19 days (p \ 0.001)] in mechanically ventilated patients. The authors concluded that the QI program involving protocol-directed weaning was associated with beneficial clinical outcomes in mechanically ventilated patients. Albert Einstein said: ''In theory, theory and practice are the same. In practice, they are not''. Healthcare quality has received sustained attention during recent years [2]. The importance of sharing its accomplishments through the published literature increases [3], particularly in the ICU setting. Quality improvement programs have been used for implementation of protocols of intubation [4, 5], sedation analgesia [6], support for families [7, 8], prevention of nosocomial infections [9, 10], or nutrition [11]. Interestingly, the study by Bo et al. [1]is the first Chinese study to present and assess a QI program in the setting of weaning of mechanical ventilation with a randomized controlled clustered design. The level of proof is high and further strengthens the results of the study.Quality improvement programs seek to apply proven treatments and recommended strategies to ''real-world'' patients. Changing practices is challenging in an ICU setting, with necessary education of a large team [12] and real-time safety audits [13]. Moving from theory to practice is harder than it looks. The Hawthorne effect was first seen in the 1920s at the Western Electric Company's Hawthorne Works, from which the term derives. The Hawthorne studies were designed to find ways to increase worker productivity. The Hawthorne effect is a psychological phenomenon that produces an improvement in human behavior or performance as a result of increased attention from superiors or colleagues. In a collaborative effort, the effect can enhance results by creating a sense of teamwork and common purpose. As suggested by Bo et al. [1] in their discussion, the Hawthorne effect was sought in the QI group, on the basis of the assessment of staff compliance with the weaning protocol by a site inspection and progress noted during the QI phase in the QI group. Power of observation is a major factor in implementing protocols and improving patient management, as formalized through the ''Deming wheel'', made popular by sta...

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A Simple Widespread Computer Help Improves Nutrition Support Orders and Decreases Infection Complications in Critically Ill Patients

Cited by 6 publications

References 37 publications

How could we make nutrition in the intensive care unit simple?

How could we make nutrition in the intensive care unit simple?

Computer‐Assisted Prescription: The Future of Nutrition Care?

From weaning theory to practice: implementation of a quality improvement program in ICU

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