A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: A cluster randomized trial in intensive care

Maartje de Vos, S.N. van der Veer, B. Wouterse, W.C. Graafmans, N. Peek, N.F. de Keizer, K.J. Jager, Gert Westert, P.H.J. van der Voort

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Abstract

Background
Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.
Methods
In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.
Results
We analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 % CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41–1.26 compared to baseline and OR 0.65; 95 % CI 0.35–1.19 compared to control group).
Conclusions
A multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.
Trial registration
ISRCTN: ISRCTN50542146
Original languageEnglish
Article number95
JournalImplementation Science
Volume10
DOIs
Publication statusPublished - 2015

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Odds Ratio
Nurses
Confidence Intervals
Intensive Care Units
Guideline Adherence
Logistic Models

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de Vos, Maartje ; van der Veer, S.N. ; Wouterse, B. ; Graafmans, W.C. ; Peek, N. ; de Keizer, N.F. ; Jager, K.J. ; Westert, Gert ; van der Voort, P.H.J. / A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards : A cluster randomized trial in intensive care . In: Implementation Science. 2015 ; Vol. 10.
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title = "A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: A cluster randomized trial in intensive care",
abstract = "BackgroundOrganizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.MethodsIn a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 {\%} or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.ResultsWe analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 {\%} confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 {\%} CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 {\%} CI 0.41–1.26 compared to baseline and OR 0.65; 95 {\%} CI 0.35–1.19 compared to control group).ConclusionsA multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.Trial registrationISRCTN: ISRCTN50542146",
author = "{de Vos}, Maartje and {van der Veer}, S.N. and B. Wouterse and W.C. Graafmans and N. Peek and {de Keizer}, N.F. and K.J. Jager and Gert Westert and {van der Voort}, P.H.J.",
year = "2015",
doi = "10.1186/s13012-015-0285-2",
language = "English",
volume = "10",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "BioMed Central",

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de Vos, M, van der Veer, SN, Wouterse, B, Graafmans, WC, Peek, N, de Keizer, NF, Jager, KJ, Westert, G & van der Voort, PHJ 2015, 'A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: A cluster randomized trial in intensive care ', Implementation Science, vol. 10, 95. https://doi.org/10.1186/s13012-015-0285-2

A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards : A cluster randomized trial in intensive care . / de Vos, Maartje; van der Veer, S.N.; Wouterse, B.; Graafmans, W.C.; Peek, N.; de Keizer, N.F.; Jager, K.J.; Westert, Gert; van der Voort, P.H.J.

In: Implementation Science, Vol. 10, 95, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards

T2 - A cluster randomized trial in intensive care

AU - de Vos, Maartje

AU - van der Veer, S.N.

AU - Wouterse, B.

AU - Graafmans, W.C.

AU - Peek, N.

AU - de Keizer, N.F.

AU - Jager, K.J.

AU - Westert, Gert

AU - van der Voort, P.H.J.

PY - 2015

Y1 - 2015

N2 - BackgroundOrganizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.MethodsIn a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.ResultsWe analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 % CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41–1.26 compared to baseline and OR 0.65; 95 % CI 0.35–1.19 compared to control group).ConclusionsA multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.Trial registrationISRCTN: ISRCTN50542146

AB - BackgroundOrganizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.MethodsIn a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.ResultsWe analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 % CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41–1.26 compared to baseline and OR 0.65; 95 % CI 0.35–1.19 compared to control group).ConclusionsA multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.Trial registrationISRCTN: ISRCTN50542146

U2 - 10.1186/s13012-015-0285-2

DO - 10.1186/s13012-015-0285-2

M3 - Article

VL - 10

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

M1 - 95

ER -