Collaborative practice and clinical outcomes in the ICU

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Objective

To evaluate the effect of organizational and managerial intervention, aimed at increasing the professional collaboration between medical and nursing staff, upon the clinical outcomes in the ICU.

Design

Prospective, randomized, multi-center and multinational study.

Setting

47 ICU's (22 control vs 25 intervention group) from 9 European countries.

Methods

All consecutive admissions were enrolled, during two periods of two months each.

Patient data

Admission data; first day SAPS II score; hourly registration of Critical Events (CrEv) defined as the duration (in hours) of out-of-range measurements of four parameters (heart rate, blood pressure, urine output and oxygen saturation); Sequential Organ Failure Score (SOFA) at admission and then every 24 h; ICU outcome.

Measurements

Final outcome: ICU mortality. Intermediate outcomes: SOFA, CrEv (expressed as the % of time spent in CrEv; single or combined), and length of stay (LOS).

Intervention

1) training of nursing and medical staff of 25 ICU's in inter-professional collaboration; 2) the use of a specific manual of instructions, supported by the daily use of two protocols covering awareness of processes of care, and professional dialogue (6 months).

Analysis

The effect of the intervention upon final and intermediate outcomes was evaluated by comparing the values of these variables in the experimental and the control groups of ICU's, before and after the intervention (Table below). SOFA computations included total daily score and Delta(Δ)-SOFA [1]. A Δ-CrEv variable was also constructed. The analyses were made on Day 1, 3 and 5, in the group of patients staying ≥ 3 and ≤ 10 days in the ICU. Χ²-test was used for comparing means; significance if P<0.05

Results

Data on 1,633 patients were obtained; there were no significant differences in the 4 `study cells' for Age (median=69), SAPS II (median=35) and LOS (median=4 days). A significant decrease in ICU mortality was observed for the intervention group (16% control group; 9% intervention group).

Conclusion

Collaborative practice has a significant and beneficial effect upon clinical outcomes in the ICU.

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