TY - JOUR
T1 - Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool
T2 - Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center
AU - Flannery, Alexander H.
AU - Thompson Bastin, Melissa L.
AU - Montgomery-Yates, Ashley
AU - Hook, Corrine
AU - Cassity, Evan
AU - Eaton, Phillip M.
AU - Morris, Peter E.
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. Methods: This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. Results: The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. Conclusions: A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.
AB - Background: Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. Methods: This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. Results: The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. Conclusions: A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.
KW - benzodiazepine
KW - critical care
KW - implementation science
KW - multidisciplinary
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85069653715&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069653715&partnerID=8YFLogxK
U2 - 10.1177/0885066618769015
DO - 10.1177/0885066618769015
M3 - Review article
C2 - 29683053
AN - SCOPUS:85069653715
SN - 0885-0666
VL - 34
SP - 707
EP - 713
JO - Journal of Intensive Care Medicine
JF - Journal of Intensive Care Medicine
IS - 9
ER -