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dc.contributor.advisorFan, Vincent Sen_US
dc.contributor.authorDale, Chrisen_US
dc.date.accessioned2012-09-13T17:33:46Z
dc.date.available2013-03-13T11:04:56Z
dc.date.issued2012-09-13
dc.date.submitted2012en_US
dc.identifier.otherDale_washington_0250O_10303.pdfen_US
dc.identifier.urihttp://hdl.handle.net/1773/20761
dc.descriptionThesis (Master's)--University of Washington, 2012en_US
dc.description.abstractIntroduction: 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.mimetypeapplication/pdfen_US
dc.language.isoen_USen_US
dc.rightsCopyright is held by the individual authors.en_US
dc.subjectHospital; Order set; Protocol; Quality Improvement; Sedation; Washingtonen_US
dc.subject.otherMedicineen_US
dc.subject.otherPublic healthen_US
dc.subject.otherHealth servicesen_US
dc.titleAssociation Between Hospital Volume and Network Membership and an Analgesia, Sedation and Delirium Order Set Quality Scoreen_US
dc.typeThesisen_US
dc.embargo.termsDelay release for 6 months -- then make Open Accessen_US


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