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1. Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database

Author

Midega, Thais Dias, Bozza, Fernando A., Machado, Flávia Ribeiro, Guimarães, Helio Penna, Salluh, Jorge I., Nassar, Antonio Paulo, Normílio-Silva, Karina, Schultz, Marcus J., Cavalcanti, Alexandre Biasi, Serpa Neto, Ary, 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, Junior, Francisco Felix Barreto, Cruz, Eduarda Maria Alves, Malbouisson, Luiz Marcelo Sa, Caltabeloti, Fabiola Prior, Bassi, Estevão, da Silva, Patrícia Regiane, Cadamuro, Filipe, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Investigators, CHECKLIST-ICU, and (BRICNet), Brazilian Research in Intensive Care Network

Subjects
ARDS, medicine.medical_specialty, lung protection, Invasive ventilation, lung protection, medicine.medical_treatment, Critical Care and Intensive Care Medicine, computer.software_genre, law.invention, Tidal volume, 03 medical and health sciences, 0302 clinical medicine, EFICIÊNCIA ORGANIZACIONAL, law, Anesthesiology, Intensive care, Medicine, low tidal volume ventilation, Intensive care unit, Organizational factors, Prospective cohort study, Mechanical ventilation, Database, business.industry, Research, Tidal volume, low tidal volume ventilation, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Confidence interval, Checklist, Invasive ventilation, 030228 respiratory system, business, computer
Abstract

Background Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV. Results The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV. Conclusions Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.

Published
2020
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3. Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients

Author

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, 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, Universidade de São Paulo (USP), Universidade Federal de Pernambuco (UFPE), Universidade Estadual Paulista (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, Universidade Estadual de Londrina (UEL), Universidade Federal do Espírito Santo (UFES), Hospital Universitário Lauro Wanderley, Hospital Universitário Onofre Lopes, Universidade Federal de Santa Catarina (UFSC), Universidade Federal da Bahia (UFBA), 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, Universidade Estadual de Campinas (UNICAMP), Vila Velha Hospital, and Vitoria Apart Hospital

Subjects
medicine.medical_specialty, business.industry, Psychological intervention, 030208 emergency & critical care medicine, General Medicine, Odds ratio, Intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, Standardized mortality ratio, Randomized controlled trial, law, Intensive care, Emergency medicine, medicine, Observational study, 030212 general & internal medicine, Cluster randomised controlled trial, Intensive care medicine, business
Abstract

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

Published
2016
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