Creating a culture of clinical excellence in critical care nutrition: the 2008 "Best of the Best" award.

OBJECTIVE

To develop, validate, and implement a system to reward top performers in critical care nutrition practice and to illuminate characteristics of top-performing intensive care units (ICUs).

DESIGN

An international, prospective, observational, cohort study conducted in May 2008.

SETTING

179 ICUs from 18 countries.

PATIENTS

2956 consecutively enrolled mechanically ventilated adult patients who stayed in the ICU for at least 72 hours.

INTERVENTIONS

To qualify for the "Best of the Best" (BOB) award, sites had to have implemented a nutrition protocol and contributed complete data on a minimum of 20 patients.

MEASUREMENTS AND MAIN RESULTS

Data on nutrition practices were collected from ICU admission to ICU discharge for a maximum of 12 days. Eligible sites were ranked based on their performance on the following 5 criteria: adequacy of provision of energy, use of enteral nutrition (EN), early initiation of EN, use of promotility drugs and small bowel feeding tubes, and adequate glycemic control. Of the 179 participating ICUs, 81 qualified for the BOB award. Overall, the average nutrition adequacy across sites was 56.2% (site range, 20.3%-90.1%). The top 10 performers were identified and publicly recognized. Regression analysis suggested that the presence of a dietitian in the ICU was associated with a high BOB award ranking, whereas being located in the United States or China, relative to other participating countries, was associated with worst performance.

CONCLUSIONS

There is variable performance with respect to critical care nutrition practices across the world.