Association Between Hospital Volume and Network Membership and an Analgesia, Sedation and Delirium Order Set Quality Score

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Association Between Hospital Volume and Network Membership and an Analgesia, Sedation and Delirium Order Set Quality Score

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dc.contributor.advisor Fan, Vincent S en_US
dc.contributor.author Dale, Chris en_US
dc.date.accessioned 2012-09-13T17:33:46Z
dc.date.available 2013-03-13T11:04:56Z
dc.date.issued 2012-09-13
dc.date.submitted 2012 en_US
dc.identifier.other Dale_washington_0250O_10303.pdf en_US
dc.identifier.uri http://hdl.handle.net/1773/20761
dc.description Thesis (Master's)--University of Washington, 2012 en_US
dc.description.abstract Introduction: Protocols for the delivery of analgesia, sedation and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniformly used. The extent to which elements of analgesia, sedation and delirium guidelines are incorporated into order sets at hospitals across a geographic area is not known. We hypothesized that both greater hospital volume and membership in a hospital network are associated with greater adherence of order sets to sedation guidelines. Methods: Sedation order sets from all non-federal hospitals without pediatric designation in Washington State that provided ongoing care to mechanically ventilated patients were collected and their content systematically abstracted. Hospital data were collected from Washington State sources and interviews with ICU leadership in each hospital. An expert-validated score of order set quality was created based on the 2002 four-society guidelines. Clustered multivariable linear regression was used to assess the relationship between hospital characteristics and the order set quality score. Results: 51 Washington State hospitals met the inclusion criteria and all provided order sets. Based on expert consensus, 21 elements were included in the sedation, analgesia, delirium order set quality score. Each element was equally weighted and contributed one-point to the score. Hospital order set quality scores ranged from 0 to 19 (median = 8, IQR 6-14). In multivariable analysis, a greater number of acute care days (P = 0.01) and membership in a larger hospital network (P = 0.01) were independently associated with a greater quality score. Conclusions: Hospital volume and membership in a larger hospital network were independently associated with a higher quality score for ICU analgesia, sedation and delirium order sets. Further research is needed to determine whether greater order-set quality is associated with improved outcomes in the critically ill. The development of critical care networks might be one strategy to improve order set quality scores. en_US
dc.format.mimetype application/pdf en_US
dc.language.iso en_US en_US
dc.subject Hospital; Order set; Protocol; Quality Improvement; Sedation; Washington en_US
dc.subject.other Medicine en_US
dc.subject.other Public health en_US
dc.subject.other Health services en_US
dc.title Association Between Hospital Volume and Network Membership and an Analgesia, Sedation and Delirium Order Set Quality Score en_US
dc.type Thesis en_US
dc.embargo.terms Delay release for 6 months -- then make Open Access en_US


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