PURPOSE: Payors and quality organizations are calling for greater compliance with ICU quality measures (best practices) to improve patient outcomes. In spite of these calls, implementation of best practices remains difficult, particularly in community hospital ICUs without dedicated intensivists, daily multi-professional rounds or other process-directed care modalities. We hypothesized that process-directed care from a remote location (eICU® facility) would enable better compliance with ICU best practices.
METHODS: We compared DVT compliance in two groups during a one month period. The first group (control) represented 67 beds in 8 ICUs that were not networked into our eICU facility and the second group (intervention arm) represented 69 beds in 7 ICUs that were networked into our remote facility. All ICU patients charts were reviewed for anticoagulant medications and devices (SCDs) ordered and meds administered; and patients were excluded if they were actively bleeding or coagulopathic (INR>1.5, and/or platelet count <50K). The intervention arm included the eICU facility nursing staff reviewing networked patients for DVT prophylaxis. When ICU patients were identified that did not have DVT prophylaxis in place (meds administered or visual assessment of SCDs) and were not coagulopathic or actively bleeding the eICU staff either contacted the attending physician (daytime hours) or the eICU physician wrote the prophylaxis orders (nighttime). The proportion of patients receiving appropriate DVT prophylaxis in monitored units was compared to non-monitored units by constructing a contingency table and tested with Fisher's exact test.
RESULTS: 220 patients charts were reviewed in the control group and 202 charts were reviewed in the intervention group. DVT prophylaxis compliance was 75% in the control and 95% in the intervention group. Relative risk of receiving DVT prophylaxis was 1.26 (p<.0001).
CONCLUSION: Improved compliance with DVT prophylaxis is obtained when these process activities are coordinated from a central location.
CLINICAL IMPLICATIONS: Centralized remote implementation of best practices may be beneficial for improving compliance for other ICU best practices and in other staffing environments.
DISCLOSURE: Glenn Giessel, None.