Compliance with triage to intensive care recommendations

Azoulay, Élie; Pochard, Frédéric; Chevret, Sylvie; Vinsonneau, Christophe; Garrouste, Maïté; Cohen, Yves; Thuong, Marie; Paugam, Catherine; Apperre, Corinne; Cagny, B de; Brun, Frédéric; Bornstain, Caroline; Parrot, Antoine; Thamion, Fabienne; Lachérade, Jean Claude; Bouffard, Y.; Gall, J. R. Le; Hervé, Christian; Grassin, Marc; Zittoun, R; Schlemmer, Benoı̂t; Dhainaut, Jean François

doi:10.1097/00003246-200111000-00014

Cited by 178 publications

(130 citation statements)

References 29 publications

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“…First, it was performed in a single country. Previous studies have shown that haematological patients are often denied ICU admission based on guidelines from learned societies [30][31][32]. However, guidelines are applied in a uniform manner across industrialised countries [33].…”

Section: Discussionmentioning

confidence: 99%

Case volume and mortality in haematological patients with acute respiratory failure

Lécuyer

Chevret²,

Guidet³

et al. 2008

Eur Respir J

105

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High case volume is associated with improved survival in medical and surgical conditions. The present study sought to determine whether intensive care unit (ICU) case volume was associated with survival of critically ill patients with haematological malignancies and acute respiratory failure (ARF).A regional database containing data from 1,753 haematological patients with ARF admitted to 28 medical ICUs from 1997 to 2004 was used. Multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors, including a propensity score that incorporates differences between ICUs with different case volumes.The three case volume tertiles were: low volume (,12 admissions per year), intermediate volume (12-30 admissions per year), and high volume (.30 admissions per year). In univariate analyses, ICU case volume was not associated with ICU mortality. After adjusting for prognostic factors for ICU mortality and the propensity score, patients in high-volume ICUs had lower mortality than other patients. A case volume increase of one admission per year led to a significant mortality reduction with an odds ratio of 0.98 (95% confidence limits 0.97-0.99). Mortality was independently associated with severity of organ dysfunction.In intensive care units admitting larger numbers of critically ill haematological patients with acute respiratory failure, mortality was lower than in other intensive care units. The mechanisms of the relationship between volume and outcome among haematological patients with acute respiratory deserve additional studies.

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Section: Discussionmentioning

confidence: 99%

Case volume and mortality in haematological patients with acute respiratory failure

Lécuyer

Chevret²,

Guidet³

et al. 2008

Eur Respir J

105

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“…A number of studies reported substantial improvement in quality both in inpatient [1,11,14,18,21,32,50,53,57,60,62,68,78] and outpatient settings [13,29,37,40,42,46]. Numerous studies, including six RCTs [4,7,38,51,63,71], failed to show any positive effects on quality associated with practice guidelines [5,10,20,25,26,36]. Results were mixed in 12 studies, in which practice guidelines improved quality for certain outcomes or patient subgroups but not others [8,23,24,41,43,52,54,55,58,59,73,74].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

“…Studies found greater effect with explicit guidelines [6,13,21,23,50,55], defined as ''systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances'' [27], although practice guidelines improved both processes and outcomes of care, including cost [14,29,53,62], and the results were greater for performance compared with patient outcomes. Clinician involvement in all aspects of guideline development was vital [5,46,53,73]. However, benefits of comprehensive dissemination and implementation need to be further clarified [36].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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“…(3)(4)(5) Genel olarak kaynak paylaşımında yararlılık, kötü davranmama, özerklik ve adalet ilkeleriyle uyum içinde YBÜ kaynaklarının tıbbi durumu geri dönüşlü olan ve tamamen iyileşme için kabul edilebilir ümidi bulunan hastalar için ayrılması önerilir. (6) Bununla birlikte ölçütlerin oluşturulması bunların uygulanması için yeterli değildir. Çünkü özellikle YBÜ yatakları gibi kritik kaynakların paylaşımında ölçütlerin nasıl yaşama geçirileceği önem taşır.…”

Section: Introductionunclassified

Justice in Intensive Care: What Admission/Discharge Criteria are used by Intensive Care Practitioners in Turkey?

Akpinar¹,

Ersoy²

2011

J Turk Anaesth Int Care

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ÖZETAmaç: Türkiye'de yoğun bakım çalışanlarının Yoğun Bakım Ünitesine (YBÜ) hasta kabul/taburcu kararlarında kullandıkları ölçütlerin belirlenmesidir.Gereç ve Yöntem: Bu çalışma 2004-2006 yıllarında 3 ulusal kongrede ve e-posta grubunda anket formuyla yürütül-dü. Yirmi ölçüt içeren form araştırmacılar tarafından hazırlandı. YBÜ çalışanlarının, karar alırken verdiği öncelikler tıbbi ve toplumsal yarar ile sosyal değer başlıklarında sorgulandı. Yanıtlar ile YBÜ çalışanlarının kişisel ve mesleki özellikleri-nin ilişkisi ki-kare testi ile değerlendirildi, p<0,05 anlamlı kabul edildi. Bulgular: Katılımcıların 228'i hekim, 136'sı hemşireydi (N=364). Hekimlerin % 82,3'ü, hemşirelerin % 53,7'si YBÜ hasta kabul/taburcu kararlarına katıldığını bildirdi. Katılımcıların % 70,9'u kaynakların sınırlılığı nedeniyle triyaj kararı veriyordu. Tıbbi yarar ölçütleri en fazla önem verilen grup olarak saptandı. Tıbbi yarar ölçütlerine verilen önem mesleki özellikler yanında sosyodemografik özelliklerden de etkilendi. Katılımcıların çoğunluğu hekim olan % 50,3'ü bir sosyal değer ölçütü olan hastanın yaşına önem verdi (p<0,05). Hastanın kendi yaşam kalitesi değerlendirmesi katılımcıların % 33,2'si için önemliydi ve çoğunluğu hemşireler oluşturuyordu (p<0,05). Toplumsal yarar açısından YBÜ çalışanlarının en fazla önem verdiği ölçüt tedavinin bilimsel biginin gelişimine katkısıydı (% 54,4).Sonuç: Etik açıdan YBÜ'ne kabul taburcu kararlarında tıbbi yarar ölçütlerinin önemsemesi uygundur. Ancak, hastanın yaşı ya da tedavinin bilimsel bilginin gelişimine katkısı ölçütlerinin önemsenmesi uygun değildir. Bu durum triyaj politikalarının oluşturulmasının gerekliliğini düşündürmektedir. Bununla birlikte tıbbi-etik karar verme sürecine hasta savunuculuğu rolü öne çıkan hemşirelerin katılımı sağlanmalıdır. Objective: To assess the decision-making criteria for patient admission and discharge used by intensive care professionals in Turkey.Materials and Methods: This trial was conducted in three national congresses and also via e-mail using a selfadministered questionnaire between 2004 and 2007. The questionnaire, which included 20 criteria of medical and societal benefits and social worth, prepared by researchers. Correlations between importance attached to the criteria, and characteristics of the participants were analyzed by chi-square test and p<0.05 was accepted significant.Results: Of 364 participants 228 were physicians and 136 nurses, also 82.3 % of the physicians and 53.7 % of the nurses were participated in admission/discharge decisions in their units. Of these 70.9 % claimed that they made triage decisions because of scarcity of resources. Medical benefit appeared to be the most important criteria. The importance given to medical benefit criteria was affected by socio-demographic characteristics, and professional capabilities as well. More than 50 % of the participants (50.3 %) which the majority was physicians gave importance to a social benefit criteria as patient's age (p<0.05). While 33.2 % them, mostly nurses, gave priority to patient...

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Compliance with triage to intensive care recommendations

Cited by 178 publications

References 29 publications

Case volume and mortality in haematological patients with acute respiratory failure

Case volume and mortality in haematological patients with acute respiratory failure

The Use of Three Strategies to Improve Quality of Care at a National Level

Justice in Intensive Care: What Admission/Discharge Criteria are used by Intensive Care Practitioners in Turkey?

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