Measurable outcomes of quality improvement in a critical care unit: the impact of a daily multidisciplinary round

Introduction

The use of care bundles in the prevention of ventilator-associated pneumonia (VAP) and other ICU complications has been increasing in critical care practice. However, the effective implementation of these strategies represents a challenge in a critical care unit. Multidisciplinary rounds (MDR) enable all members of the team caring for critically ill patients to come together and offer expertise in patient care. This intervention has proven successful in medical and surgical settings. The objective of the present study was to assess the effectiveness of a daily MDR to improve compliance with the VAP bundle recommendations and other beneficial prophylactic measures in a high-volume critical care unit.

Methods

A prospective before–after design was used to examine the effectiveness of daily MDR in promoting compliance with prophylactic measures for VAP, deep venous thrombosis or pulmonary embolism, central line infection and other ICU complications. Compliance was assessed for 1 month before institution of the MDR and it was assessed for the next month after implementation of MDR.

Results

During the study period, daily survey information was collected. The demographic characteristics of the ICU patients surveyed remained constant. Implementation of the MDR facilitated improvement of all measures. Compliance with VAP prevention measures of head-of-bed elevation >30° (47.2% vs 72.5%), sedation holiday (35.0% vs 92.0%), and prophylaxis for both peptic ulcer disease (90.2% vs 92.3%) and deep venous thrombosis (72% vs 92%) were all increased. A decrease in central line duration >72 hours (90.4% vs 70.8%), ventilator duration >72 hours (85.0% vs 72%) and duration of ICU stay (4.7 days vs 3.9 days) was also noted.

Conclusion

Our study demonstrates that implementation of the MDR can make an impact not only in the rates of compliance with standard-of-care prophylactic measures, but also in the reduction of central line, ventilator and ICU stay duration in a high-volume critical care unit.