The Association of ICU Acuity With Adherence to ICU Evidence-Based Processes of Care

Kelly C. Vranas, Jennifer Y. Scott, Omar Badawi, Michael O. Harhay, Christopher G. Slatore, Donald R. Sullivan, Meeta Prasad Kerlin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Admission to high-acuity ICUs has been associated with improved outcomes compared with outcomes in low-acuity ICUs, although the mechanism for these findings is unclear. Research Question: The goal of this study was to determine if high-acuity ICUs more effectively implement evidence-based processes of care that have been associated with improved clinical outcomes. Study Design and Methods: This retrospective cohort study was performed in adult ICU patients admitted to 322 ICUs in 199 hospitals in the Philips ICU telemedicine database between 2010 and 2015. The primary exposure was ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles. Multivariable logistic regression was used to examine relations of ICU acuity with adherence to evidence-based VTE and stress ulcer prophylaxis, and with the avoidance of potentially harmful events. These events included hypoglycemia, sustained hyperglycemia, and liberal transfusion practices (defined as RBC transfusions prescribed for nonbleeding patients with preceding hemoglobin levels ≥ 7 g/dL). Results: Among 1,058,510 ICU admissions, adherence to VTE and stress ulcer prophylaxis was high across acuity levels. In adjusted analyses, those admitted to low-acuity ICUs compared with the highest acuity ICUs were more likely to experience hypoglycemic events (adjusted OR [aOR], 1.12; 95% CI, 1.04-1.19), sustained hyperglycemia (aOR, 1.07; 95% CI, 1.04-1.10), and liberal transfusion practices (aOR, 1.55; 95% CI, 1.33-1.82). Interpretation: High-acuity ICUs were associated with better adherence to several evidence-based practices, which may be a marker of high-quality care. Future research should investigate how high-acuity ICUs approach ICU organization to identify targets for improving the quality of critical care across all ICU acuity levels.

Original languageEnglish (US)
Pages (from-to)579-587
Number of pages9
JournalCHEST
Volume158
Issue number2
DOIs
StatePublished - Aug 2020

Keywords

  • ICU
  • critical care
  • evidence-based medicine
  • guidelines
  • patient safety

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'The Association of ICU Acuity With Adherence to ICU Evidence-Based Processes of Care'. Together they form a unique fingerprint.

Cite this