Detalhes do Documento

Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: A randomized clinical trial

Autor(es): Cavalcanti, Alexandre B. ; Bozza, Fernando Augusto ; Machado, Flavia R. ; Salluh, Jorge I.F. ; Campagnucci, Valquiria Pelisser ; Vendramim, Patricia ; Guimaraes, Helio Penna ; Normilio-Silva, Karina ; Damiani, Lucas Petri ; Romano, Edson ; Carrara, Fernanda ; de Souza, Juliana Lubarino Diniz ; Silva, Aline Reis ; Ramos, Grazielle Viana ; da Silva, Nilton Brandão ; Chang, Chung-Chou H. ; Angus, Derek C. ; Berwanger, Otavio ; Neto, Pedro Aniceto Nunes ; Fernandes, Carlos Alberto ; Luchesi, Cristiano Ávila ; de Sa, Natalia Rodrigues ; Rodrigues, Roberta Antunes Faria ; Radespiel, Larissa Stefany ; dos Santos Iorio, Vinicius Leonardo ; Bhering, Danielle ; Linhares, Viviane Ribeiro ; Westphal, Glauco Adrieno ; Sperotto, Geonice ; da Silva Rossi, Soraya Byana Rezende ; Ferreira, Thaismari Escarmanhani ; de Brito Sobrinho, Edgar ; Reis, Helder Jose Lima ; Carneiro, Mauricio Soares ; de Oliveira Lameira Veríssimo, Adriana ; Fernandes, Juliana Fernandez ; Ferreira, Rodrigo Lopes ; Pinho, Sylvania Campos ; Dultra, Leonardo ; Hizumi, Lise Oliveira ; de Lima, Neiva Fernandes ; da Silva, Alexsandra Raimunda ; dos Santos, Liliane ; Vaz, Sidiner Mesquita ; Oliveira, José Marcio ; Laviola, Miria Bonjour ; de Freitas, Wania Vasconcelos ; Passos, Leonardo ; Rabello, Ligia Sarmet Cunha Farah ; de Siqueira, Carollina Resende ; de Oliveira Silva, Luiz Carlos ; Barreto, Francisco Felix ; Cruz, Eduarda Maria Alves ; Sa Malbouisson, Luiz Marcelo ; Caltabeloti, Fabiola Prior ; Bassi, Estevão ; da Silva, Patrícia Regiane ; Cadamuro, Filipe ; dos Santos Cagnon, Renata Graciliano ; Ho, Yeh-Li ; Neto, Lucas Chaves ; Randi, Bruno Azevedo ; de Godoy, Michele Maria Goncalves ; Sobral, Pollyanna Dutra ; de Barros Campelo, Evônio ; de Stefano, Laercio Martins [UNESP] ; Gut, Ana Lucia [UNESP] ; de Stefano, Greicy Mara Mengue Feniman [UNESP] ; Ferreira, Denise Milioli ; Gonçalves, Fernanda Alves Ferreira ; Alves, Fernanda Rubia Negrao ; Filho, Wilson Nogueira ; Marchetti, Renata Ortiz ; Sa, Sheila ; Anabuki, Nadia Tomiko ; Vieira, Silvia Regina Rios ; Parolo, Edino ; Prado, Karen ; Lisboa, Natalia Gomes ; Fortaleza, Simone Castelo Branco ; Porfirio, Maria Liduina Nantua Beserra ; Colares, Marcela Maria Sousa ; da Silva, Rosicley Souza ; Vasconcelos, Marcia ; de Souza, Fabio ; de Figueiredo, Lanese Medeiros ; Seabra, Niedila Pinheiro Bastos ; de Oliveira, Paula Celia Pires ; Martins, Marcio Andrade ; Muller, Ricardo Beduschi ; Recalcatti, Manoela Cristina ; Martins, Riani Helenditi Fernandes Camurça ; de França, Leatrice Emilia Ferreira ; de Carvalho, Frederico Bruzzi ; Moreira, Gustavo Cesar Augusto ; Cechinatti, Evelin Drociunas Pacheco ; Passos, Aline Cristina ; da Costa Ferreira, Mariana ; Rodrigues, Antonio Carlos Babo ; dos Santos Begni, Vladimir ; Jardim, Alfredo Maximo Grilo ; Maciel, Amanda Carvalho ; Thompson, Marlus Muri ; Pinheiro, Erica Palacio Berçacola ; Gonçalves, Claudio Henrique Pinto ; Rosenfeld, Ricardo Schilling ; Rosenfeld, Valéria Abrahao ; Japiassú, Leticia ; de Oliveira Bissoli, Maria Inês Pinto ; da Costa Tavares, Rosemary ; Gonçalves, Marta Rocha ; Martins, Laercia Ferreira ; Oliveira, Maria Helena ; Ferreira, Adriana Kelly Almeida ; Lima, Emídio Jorge Santos ; de Almeida Oliveira, Tárcio ; Campos, Milena Teixeira ; de Freitas, Nilce Almino ; da Silva, Stephanie Wilkes ; Ferreira, Vera Lucia Bento ; de Oliveira Sodré, Alexander ; Villela, Cid Leite ; Medeiros, Eduardo Duque Estrada ; de Souza Junior, Nairo Jose ; de Souza Maya Nunes, Jhocrenilcy ; de Souza Monteiro, Rones ; Ribeiro, André Scazufka ; Giovanini, Carlos Cesar Nogueira ; Carvalho, Elisete Tavares ; Fernandes, Lenise Castelo Branco Camurça ; Rocha, Domitilha Maria Coelho ; de Freitas, Cristiane Maria Gadelha ; de Magalhaes Menezes, Marcia Adélia ; Stancato, Rosa Imaculada ; Faria, Guilherme Brenande Alves ; Asturi, Giovanna ; Bergo, Ricardo Reinaldo ; Dall'Orto, Frederico Toledo Campo ; Ribeiro, Gislayne Rogante ; Arantes, Cidamaiá Aparecida ; dos Santos Toneto, Michelle Aparecida ; Teixeira, Cassiano ; Maccari, Juçara Gasparetto ; Górios, Sergio Tadeu ; de Morais, Julliana Pires ; Zambelli, Daniela Marangoni ; de Souza, Roberta Machado ; de Paiva, Eduardo Cenísio Teixeira ; Ribeiro, Alessandra Gonçalves ; Pereira, Marcus Vinicius ; Nascimento, Leoni ; da Silva, Rosangela ; de Almeida, Roberto ; Couto, Karin Aline Zilli ; Toffolo, Izabella Moroni ; da Rocha Paranhos, Jorge Eduardo ; Fraga, Antonio Ricardo Paixão ; de Oliveira, Alberto Augusto ; Lannes, Roberto ; da Silva Gomes Ludovico, Andrea ; Carvalho, Luiz Fernando Costa ; de Araújo Campos, Leticia ; Soboslai, Patricia ; Maia, Israel Silva ; Rassele, Tatiana ; Zanzi, Christiany ; Michel, Valeria Nunes Martins ; Gonçalves, Sinésio Pontes ; de Oliveira Gargioni, Ricardo Rath ; Duarte, Rosangela Zen ; D'Agostino Dias, Mariza ; Diziola, Andrea Delfini ; da Silva, Daniela Veruska ; Hagihara, Melissa Sayuri ; de Oliveira, André Luís Veiga ; Reis, Diego Leonnardo ; Feijó, Janaina ; da Costa Oliveira, Marco Antonio ; de Souza, Luiza Veiga Coelho ; de Oliveira Cavalcante, Liane ; Rodrigues, Jacilda ; de Pinho, Moises Cruz ; Maia, Marcos Antonio Gadelha ; Lima, Vladia Fabiola Jorge ; Nogueira, Emilianny Maria ; Gomes, Antonielle Carneiro ; de Oliveira, Katia Regina ; Bandeira, Jose Antonio ; Mesquita, Carla Cordeiro Botelho ; Arcaro, Guilherme ; Wolff, Camila ; Filho, Délcio Caran Bertucci ; Betonico, Gustavo Navarro ; Maroto, Rafaela Pereira ; Menegon, Leonardo Fantinato ; Henrique da Silveira, Patrício ; de Queiroga Oliveira, Germana Estrela Gadelha ; da Silva Lima, Wallber Moreno ; Nunes, Lilian Batista ; Neto, Sotero Gonçalves Martins ; de Oliveira Lopes Lima, Liwcy Keller ; de Mendonça Lima, Maria Augusta ; Milagres, Lidiane Miranda ; D'Ávila, Vivian Gribel ; Schiavetto, Paulo Marcelo ; dos Santos, Paulo Alves ; de Matos Raimundo, Francislaine ; de Melo, Carmen Leonilia Tavares ; de Carvalho, Aline Albuquerque ; de Santana, Cynthia Franca ; Fonseca, Adriana Lessa Ventura ; da Silva, Martha Aparecida ; Nasrala, Mara Lilian Soares ; Pinheiro, Eloisa Kohl ; Santos, Mara Regina Pereira ; da Silva, Guilherme Abdalla ; Moreira, Rener ; Sebold, Marcia Loureiro ; da Rocha, Marcone Lisboa Simões ; Leão, Marco Antonio Ribeiro ; de Assis, Jaqueline ; Dal Pizzol, Felipe ; Tomasi, Cristiane Damiani ; da Silva, Jose Nivon ; Fragoso, Luciana Vladia Carvalhedo ; Barros, Denise Araújo Silva Nepomuceno ; Coutinho, Mauricio Mattos ; Pereira, Robson Sobreira ; dos Santos, Veronica Oliveira ; Macedo, Sergio Kiffer ; de Souza Bouzaga Furlani, Diego ; Aglio, Eduardo Silva ; de Góis, Aécio Flavio Teixeira ; Teixeira, Kathia ; Ping, Paula Zhao Xiao ; Viecili, Paulo Ricardo Nazario ; de Almeida, Simone Daniela Melo ; Santos, Geovani Moreno ; Segundo, Djalma Novaes Araújo ; Santana, Marielle Xavier ; Calvete, Jose Oliveira ; Renner, Luciana ; Francisco, Vinicius Vandré Trindade ; de Carvalho, Danytieli Silva ; da Silva Batista Campos, Adriana Neri ; Curvelo, Sergio Leôncio Fernandes ; de Oliveira, Nayara Ribas ; de Paula Freitas Deborssan, Suelem ; dos Anjos Silva Guimaraes, Maria Raquel ; Bastos, Luiz Claudio Gomes ; Gomes, Luciene Moraes ; de Lima Vale, Erico ; da Silva, Dionísia Arianne Vieira ; Gomes, Renato Vieira ; Mattos, Marco Antonio ; Nogueira, Pedro Miguel Matos ; Nascimento, Viviane Cristina Caetano ; Grion, Cintia Magalhaes Carvalho ; Dias, Alexsandro Oliveira ; de Souza Omori Maier, Glaucia ; Vassallo, Paula Frizera ; de Lima, Maria Helena Buarque Souza ; dos Reis, Wyllyam Loss ; Loureiro, Walace Lirio ; Borghardt, Andressa Tomazini ; Mendes, Ciro Leite ; Gottardo, Paulo Cesar ; Neto, Jose Melquiades Ramalho ; da Silva, Eliane Pereira ; da Silva Aragao, Maria Gorette Lourenço ; de Lima, Elisângela Maria ; de Souza, Rafael Lisboa ; Takashiba, Ken Sekine ; Gusmão-Flores, Dimitri ; Araújo, Taciana Lago ; Mota, Rosana Santos ; Germano, Almir ; Antunes, Flavia ; Bin Silva, Sandra Regina ; Guerreiro, Marcio Osório ; Bainy, Marina Peres ; de Azevedo Duarte Hardt, Patrícia ; de Andrade Urbano, Hugo Correa ; de Souza, Camila Amurim ; Mangini, Claudia ; da Silva Ramos, Fernando Jose ; de Araújo, Luany Pereira ; Japiassú, André Miguel ; Medeiros, Denise Machado ; da Silva, Michele Fernanda Borges ; Hirata, Fabiano ; Marco, Roberto ; Peixoto, Elzo ; Esmeraldo, Marcio Luiz Fortuna ; Pereira, Leide Aparecida Damásio ; Leal, Raquel Carvalho ; Torres, Paulo Roberto Aranha ; Torres, Maricy Morbin ; de Moura, Mara Rubia ; de Oliveira, Claudio Dornas ; Moreira, Andressa Siuves Gonçalves ; Ferreira, Brisa Emanuelle Silva ; dos Santos Cruz, Carolina Leticia ; Soares, Patrícia Moreira ; Correia, Paulo Cesar ; Almeida, Lorena Lina Silva ; Sousa, Marcelo Ferreira ; Vial, Andrey Antonio Santiago ; Souza, Marcia Maria Ferreira ; Quintana, Diogo ; Guimaraes, Ana Cecilia Barbosa ; Diniz, Maria Dolores Menezes ; Ferreira, Paulo Henrique Panelli ; Cordeiro, Rosa Maria Rios Santana ; da Cunha Mendes, Murilo Oliveira ; de Lima, Sergio Oliveira ; Bezerra, Silvia Aparecida ; dos Reis da Silva, Aurélia Baquiao ; Batista, Cristiano Correa ; Neumann, Thaís ; Leite, Rafael Olivé ; Lisboa, Thiago Costa ; Hädrich, Martha ; Filho, Edison Moraes Rodrigues ; da Rocha Paranhos, Jorge Luiz ; dos Santos, Carlos Henrique Nascimento ; de Souza, Hélia Cristina ; de Souza, Robson Viera ; Cuadra, Jose Luís Toribio ; Spanholi, Jonas ; de Carvalho Borges, Marcos ; Lovato, Wilson Jose ; Gomes, Tania Mara ; Machado, Luís Artur Mauro Witzel ; Santos, Thiago Martins ; de Carvalho Filho, Marco Antonio ; Bernardes, Karina Aparecida Garcia ; Santos, Jose Roberto Pereira ; Liparizi, Aline Esteves Mautoni Queiroga ; Lana, Patrícia Venturim ; Piras, Claudio ; Nespoli, Luiz Virgílio ; Taliule, Aparecida Silva

Data: 2021

Identificador Persistente: http://hdl.handle.net/11449/206485

Origem: Oasisbr


Descrição

Made available in DSpace on 2021-06-25T10:32:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-04-12

Asian Development Bank

American Dysautonomia Institute

Armed Forces Health Surveillance Branch

Health Systems Institute

ACG Institute for Clinical Research and Education

Ministério da Saúde

IMPORTANCE: The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. OBJECTIVE: To determine whether a multifaceted quality improvement intervention reduces the mortality of critically ill adults. DESIGN, SETTING, AND PARTICIPANTS: This study had 2 phases. Phase 1 was an observational study to assess baseline data on work climate, care processes, and clinical outcomes, conducted between August 2013 and March 2014 in 118 Brazilian ICUs. Phase 2 was a cluster randomized trial conducted between April and November 2014 with the same ICUs. The first 60 admissions of longer than 48 hours per ICU were enrolled in each phase. INTERVENTIONS: Intensive care units were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician promptingfor 11 care processes, or to routine care. MAIN OUTCOMES AND MEASURES: In-hospital mortality truncated at 60 days (primary outcome) was analyzed using a random-effects logistic regression model, adjusted for patients' severity and the ICU's baseline standardized mortality ratio. Exploratory secondary outcomes included adherence to care processes, safety climate, and clinical events. RESULTS: A total of 6877 patients (mean age, 59.7 years; 3218 [46.8%] women) were enrolled in the baseline (observational) phase and 6761 (mean age, 59.6 years; 3098 [45.8%] women) in the randomized phase, with 3327 patients enrolled in ICUs (n = 59) assigned to the intervention group and 3434 patients in ICUs (n = 59) assigned to routine care. There was no significant difference in in-hospital mortality between the intervention group and the usual care group, with 1096 deaths (32.9%) and 1196 deaths (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P =.88). Among 20 prespecified secondary outcomes not adjusted for multiple comparisons, 6 were significantly improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate), whereas there were no significant differences between the intervention group and the control group for 14 outcomes (ICU mortality, central line-associated bloodstream infection, ventilator-associated pneumonia, urinary tract infection, mean ventilator-free days, mean ICU length of stay, mean hospital length of stay, bed elevation to ≥30°, venous thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, perception of management, and perception of working conditions). CONCLUSIONS AND RELEVANCE: Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality.

Research Institute HCor-Hospital do Coração, Rua Abílio Soares 250, 12th Floor

Research Institute HCor-Hospital do Coração

D'Or Institute for Research and Education

Oswaldo Cruz Foundation

Latin American Sepsis Institute

Hospital Samaritano

Hospital Moinhos de Vento

University of Pittsburgh

Casa de Saúde Santa Marta

Casa de Saúde São Bento

Centro Hospitalar Unimed

Complexo Hospitalar São Mateus

Fundação Hospital de Clinicas Gaspar Vianna

Fundação Hospital Getúlio Vargas

Hospital Aristides Maltez

Hospital Aviccena

Hospital Casa de Caridade de Carangola

Hospital Casa de Portugal

Hospital Copa D'Or

Hospital da Sagrada Familia

Hospital das Clinicas-FMUSP

Hospital das Clinicas da UFPE

Hospital das Clínicas Faculdade de Medicina de Botucatu/UNESP

Hospital das Clinicas de Goiás

Hospital das Clinicas Luzia de Pinho Melo-SPDM

Hospital de Base do Distrito Federal

Hospital de Clinicas de Porto Alegre

Hospital de Messejana Dr Carlos Alberto Studart Gomes

Hospital de Urgência e Emergência de Rio Branco

Hospital Distrital Dr Evandro Ayres de Moura

Hospital do Coração Balneário Camboriú

Hospital e Pronto Socorro Dr Aristóteles Platao Bezerra de Araújo

Hospital Eduardo de Menezes

Hospital Estadual Américo Brasiliense

Hospital Estadual Getúlio Vargas-Secretaria de Estado de Saúde

Hospital Estadual Monsenhor Walfredo Gurgel

Hospital Evangélico de Cachoeira de Itapemirim

Hospital Federal da Lagoa

Hospital Federal Servidores do Estado

Hospital Fernandes Tavora

Hospital Geral de Camaçari

Hospital Geral de Fortaleza

Hospital Geral de Nova Iguaçu

Hospital Geral de Palmas

Hospital Guilherme Álvaro

Hospital Instituto Dr Jose Frota

Hospital Joari

Hospital Maternidade e Pronto Socorro Santa Lucia

Hospital Maternidade Municipal Dr Odelmo Leão Carneiro

Hospital Municipal Dr Carmino Caricchio

Hospital Municipal de Paracatu

Hospital Municipal Dr Mario Gatti

Hospital Municipal Padre Germano Lauck de Foz do Iguaçu

Hospital Municipal Pedro II

Hospital Municipal Souza Aguiar

Hospital Naval Marcilio Dias

Hospital Nereu Ramos

Hospital Nossa Senhora Auxiliadora

Hospital Nossa Senhora dos Prazeres

Hospital 9 de Julho

Hospital Primavera

Hospital Procordis

Hospital Pronto Socorro 28 de Agosto

Hospital Regional da Unimed Fortaleza

Hospital Regional de Juazeiro

Hospital Universitário Regional dos Campos Gerais

Hospital Regional de Presidente Prudente

Hospital Regional Deputado Manoel Gonçalves Abrantes

Hospital Regional Público do Araguaia

Hospital Regional João Penido

Hospital Santa Casa de Campo Mourão

Hospital Municipal Santa Isabel-Joao Pessoa

Hospital Santa Lucia de Divinópolis

Hospital Santa Rosa

Hospital Municipal São Francisco de Assis

Hospital São Joao de Deus

Hospital São Jose-Criciúma

Hospital São Jose de Doenças Infecciosas

Hospital São Jose de Teresópolis

Hospital São Jose do Avaí

Hospital São Paulo

Hospital São Vicente de Paula-Cruz Alta

Hospital São Vicente de Paulo-Vitória da Conquista

Hospital São Vicente de Paulo-Passo Fundo

Hospital Unimed Bebedouro

Hospital Unimed Costa do Sol

Hospital Unimed Maceió

Hospital Unimed Natal

Hospital Unimed Rio

Hospital Universitário-Universidade Estadual de Londrina

Hospital Universitário Cassiano Antonio Moraes-Universidade Federal do Espirito Santo

Hospital Universitário Lauro Wanderley

Hospital Universitário Onofre Lopes

Hospital Universitário Polydoro Ernani de São Thiago-Universidade Federal de Santa Catarina

Hospital Universitário Prof. Edgar Santos-Universidade Federal da Bahia

Hospital Universitário Regional de Maringá

Hospital Universitário São Francisco de Paula-Pelotas

Hospital Vila da Serra-Instituto Materno Infantil de Minas Gerais

Hospital Vivalle

Instituto Nacional de Infectologia Evandro Chagas/Fiocruz

Irmandade da Santa Casa de Misericórdia de São Paulo

Irmandade do Hospital Nossa Senhora das Dores

Irmandade Santa Casa de Misericórdia de Maringá

Santa Casa de Belo Horizonte

Santa Casa de Caridade de Diamantina

Santa Casa de Misericórdia de Anapolis

Santa Casa de Misericórdia de Feira de Santana

Santa Casa de Misericórdia de Guaxupé

Santa Casa de Misericórdia de Pelotas

Santa Casa de Misericórdia de Porto Alegre

Santa Casa de Misericórdia de São Joao Del Rei

Sociedade Beneficente Hospitalar Maravilha

Unidade de Emergência Hospital das Clinicas de Ribeirão Preto-FMRP-USP

Hospital de Clinicas-Universidade Estadual de Campinas

Vila Velha Hospital

Vitoria Apart Hospital

Hospital das Clínicas Faculdade de Medicina de Botucatu/UNESP

Tipo de Documento Artigo científico
Idioma Inglês
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