2 research outputs found
Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation
Objective We aimed to explore: the exposure
of healthcare workers to a delirium guidelines
implementation programme; effects on guideline
adherence at intensive care unit (ICU) level; impact
on knowledge and barriers, and experiences with the
implementation.
Design A mixed-methods process evaluation of a
prospective multicentre implementation study.
Setting Six ICUs.
Participants 4449 adult ICU patients and 500 ICU
professionals approximately.
Intervention A tailored implementation programme.
Main outcome measure Adherence to delirium
guidelines recommendations at ICU level before, during
and after implementation; knowledge and perceived
barriers; and experiences with the implementation.
Results Five of six ICUs were exposed to all
implementation strategies as planned. More than 85%
followed the required e-learnings; 92% of the nurses
attended the clinical classroom lessons; five ICUs used
all available implementation strategies and perceived
to have implemented all guideline recommendations
(>90%). Adherence to predefined performance indicators
(PIs) at ICU level was only above the preset target
(>85%) for delirium screening. For all other PIs, the
inter-ICU variability was between 34% and 72%. The
implementation of delirium guidelines was feasible and
successful in resolving the majority of barriers found
before the implementation. The improvement was well
sustained 6months after full guideline implementation.
Knowledge about delirium was improved (from 61% to
65%). The implementation programme was experienced as
very successful.
Conclusions Multifaceted implementation can improve
and sustain adherence to delirium guidelines, is feasible
and can largely be performed as planned. However,
variability in delirium guideline adherence at individual
ICUs remains a challenge, indicating the need for more
tailoring at centre level
Postoperative mortality in the Netherlands: A population-based analysis of surgery-specific risk in sdults
BACKGROUND: Few data are available that systematically describe rates and trends of postoperative mortality for fairly large, unselected patient populations. METHODS: This population-based study uses a registry of 3.7 million surgical procedures in 102 hospitals in The Netherlands during 1991-2005. Patients older than 20 yr who underwent an elective, nonday case, open surgical procedure were enrolled. Patient data included main (discharge) diagnosis, secondary diagnoses, dates of admission and discharge, death during admission, operations, age, sex, and a limited number of comorbidities classified according to the International Classification of Diseases 9th revision Clinical Modification. The main outcome measure was postoperative all-cause mortality. Univariable and multivariable logistic regression analyses were applied to evaluate the relationship between type of surgery and the main outcome. RESULTS: Postoperative all-cause death was observed in 67,879 patients (1.85%). In a model based on a classification into 11 main surgical categories, breast surgery was associated with lowest mortality (adjusted incidence, 0.07%), and vascular surgery was associated with highest mortality (adjusted incidence, 5.97%). In a model based on 36 surgical subcategories, the adjusted mortality ranged from 0.07% for hernia nuclei pulposus surgery to 18.5% for liver transplant. The c-index of the 36-category model was 0.88, which was significantly (P < 0.001) higher than the c-index that was associated with the simple surgical classification (low vs. high risk) in the commonly used Revi