Kohn Rachel, Madden Vanessa, Kahn Jeremy M, Asch David A, Barnato Amber E, Halpern Scott D, Kerlin Meeta Prasad
1 Department of Medicine.
2 Center for Clinical Epidemiology and Biostatistics, and.
Ann Am Thorac Soc. 2017 Feb;14(2):254-261. doi: 10.1513/AnnalsATS.201607-579OC.
Several intensive care unit (ICU) organizational practices have been associated with improved patient outcomes. However, the uptake of these evidence-based practices is unknown.
To assess diffusion of ICU organizational practices across the state of Pennsylvania.
We conducted two web-based, cross-sectional surveys of ICU organizational practices in Pennsylvania acute care hospitals, in 2005 (chief nursing officer respondents) and 2014 (ICU nurse manager respondents).
Of 223 eligible respondents, nurse managers from 136 (61%) medical, surgical, mixed medical-surgical, cardiac, and specialty ICUs in 98 hospitals completed the 2014 survey, compared with 124 of 164 (76%) chief nursing officers in the 2005 survey. In 2014, daytime physician staffing models varied widely, with 23 of 136 (17%) using closed models and 33 (24%) offering no intensivist staffing. Nighttime intensivist staffing was used in 37 (27%) ICUs, 38 (28%) used nonintensivist attending staffing, and 24 (18%) had no nighttime attending physicians. Daily multidisciplinary rounds occurred in 93 (68%) ICUs. Regular participants included clinical pharmacists in 68 of 93 (73%) ICUs, respiratory therapists in 62 (67%), and advanced practitioners in 37 (39%). Patients and family members participated in rounds in 36 (39%) ICUs. Clinical protocols or checklists for mechanically ventilated patients were available in 128 of 133 (96%) ICUs, low tidal volume ventilation for acute respiratory distress syndrome in 54 of 132 (41%) ICUs, prone positioning for severe acute respiratory distress syndrome in 37 of 134 (28%) ICUs, and family meetings in 19 of 134 (14%) ICUs. Among 61 ICUs that responded to both surveys, there was a significant increase in the proportion of ICUs using nighttime in-ICU attending physicians (23 [38%] in 2005 vs. 30 [49%] in 2014; P = 0.006).
The diffusion of evidence-based ICU organizational practices has been variable across the state of Pennsylvania. Only half of Pennsylvania ICUs have intensivists dedicated to the ICU. Variable numbers use clinical protocols for life-saving therapies, and few use structured family engagement strategies. In contrast, the diffusion of non-evidence-based practices, including overnight ICU attending physician staffing, is increasing. Future research should focus on promoting implementation of organizational evidence to promote high-quality ICU care.
重症监护病房（ICU）的几种组织管理方法已被证实与改善患者预后相关。然而，这些基于证据的方法的采用情况尚不清楚。
评估宾夕法尼亚州ICU组织管理方法的推广情况。
我们于2005年（调查对象为首席护理官）和2014年（调查对象为ICU护士长）对宾夕法尼亚州急症护理医院的ICU组织管理方法进行了两次基于网络的横断面调查。
在223名符合条件的受访者中，2014年有来自98家医院的136个（61%）医疗、外科、医疗 - 外科混合、心脏及专科ICU的护士长完成了调查，而2005年164名首席护理官中有124名（76%）完成了调查。2014年，日间医生排班模式差异很大，136个ICU中有23个（17%）采用封闭式排班，33个（24%）没有配备专科医生。37个（27%）ICU采用夜间专科医生排班，38个（28%）采用非专科医生值班，24个（18%）没有夜间值班医生。93个（68%）ICU每天进行多学科查房。常规参与者包括93个ICU中的68个（73%）的临床药师、62个（67%）的呼吸治疗师以及37个（
