In:
BMJ Open, BMJ, Vol. 11, No. 6 ( 2021-06), p. e042302-
Kurzfassung:
Daily multidisciplinary rounds (DMRs) consist of systematic
patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the
present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on
care performance will reduce ICU length of stay compared with a control group. Methods and analysis A multicentre, controlled, cluster-randomised superiority trial
including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised
to a complex-intervention compo sed by daily rounds carried out through
Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local
leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary
outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality
rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral
feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the
beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8
ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an
intensivist, specialised or step-down units. Ethics and dissemination The study protocol was approved by the institutional review board
(IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for
submission before the end of patient’s enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each
participating unit. Trial registration number NCT03920501 ; Pre-results.
Materialart:
Online-Ressource
ISSN:
2044-6055
,
2044-6055
DOI:
10.1136/bmjopen-2020-042302
DOI:
10.1136/bmjopen-2020-042302.supp1
DOI:
10.1136/bmjopen-2020-042302.supp2
Sprache:
Englisch
Verlag:
BMJ
Publikationsdatum:
2021
ZDB Id:
2599832-8