HSC Section 3 - Trauma, Critical Care and Sleep Medicine

O’Toole et al

Table 1. Population Characteristics of Pre- and Postintervention Groups.

Prebundle (n = 183)

Postbundle (n = 155)

n

%

n

%

P Value

60.36 a 22.99 a 18.51 a

57.28 a 22.48 a 18.37 a

.065 .722 .911 .275

Age, y

Length of stay, d

Days in intensive care unit

Sex

Female

84 99

46 54

62 93

40 60

Male

Race/ethnicity

.283

Black

77 27 62

46 16 37

58 18 65 16 30 26 28 19 36 15 62 78 28 11 60 45 36 32 27 23 1

41 13 46 10 19 17 18 12 23 10 40 50 18

Hispanic

White

Charlson/Deyo score

.096

0 1 2 3 4

9

5

24 26 36 26 62 26 67 90 49

13 14 20 14 34 14 37 49 27

5

Service

.429

Cardiothoracic Otolaryngology General surgery

Congestive heart failure Peripheral vascular disease Cerebrovascular disease

.057

6

3

7

.11

82

45

39

.258 .242 .673 .601 .786

Dementia

4

2

1

Chronic obstructive pulmonary disease

57 47 40 51 34

31 26 22 28 19

29 23 21 17 15

Diabetes

Hemiplegia/paraplegia

.023 b

Renal disease

Cancer

.36

Moderate/severe liver disease

4

2

4

3

.812

a Mean. b P \ .05.

improving outcomes using bundles. 14 Still, no pressure ulcers were identified in the group of 19 patients involved in the audit. A fundamental assumption of bundles is that strong evidence-based recommendations for improving an outcome exist. This allows improvement efforts to focus not on deter- mining what needs to be done to improve an outcome but instead on improving reproducibility and consistency in delivered care. Unfortunately, there is a lack of high-quality evidence to support recommendations regarding the perio- perative care for adult patients with tracheostomies, espe- cially in regard to prevention of TRAPUs. Therefore, the group of interventions described in our study was derived from clinical practice guidelines, avail- able scientific evidence, and clinical observations. A recent consensus statement on tracheostomy care supported initial exchange of the tracheostomy tube between 3 and 7 days.

based interventions that could be applied to a discrete patient population in a specific health care setting that, when employed together, improve outcomes in a synergistic manner. The original bundles of interventions were designed to improve the care of patients in intensive care units who received mechanical ventila- tion or central lines. 14 The success of bundles in improving out- comes is dependent on having evidence-based recommendations that have been shown to improve outcomes and then focusing efforts on attaining 100% compliance with all recommendations for every patient to which they apply. To support this objective, compliance is measured in an all-or-none fashion, with each patient’s care being judged as either entirely compliant or noncompliant. 14 During the ini- tial audit period of this study, 84% of the patients audited had care that was found to be completely compliant with the standardized treatment protocol. This is less than the goal of 95% compliance that has been proposed for

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