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(a) principal: Cavalcanti, Alexandre B.
• Data de Publicação: 2016
• Outros Autores: 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
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://dx.doi.org/10.1001/jama.2016.3463; http://hdl.handle.net/11449/206485

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.