PURPOSE: Clinical protocols to standardize care may improve patient outcomes but worsen trainee education. Our objective was to determine the availability of clinical protocols in teaching medical intensive care units (ICUs). MATERIALS AND METHODS: We administered an electronic questionnaire regarding protocol availability in 5 specific clinical areas. All directors of adult medical ICUs in US teaching hospitals were eligible to participate. RESULTS: The response rate was 70%. Eighty-six percent of ICU directors reported availability of protocols for ventilation liberation, 73% for sedation, 62% for sepsis resuscitation, 60% for lung-protective ventilation, and 48% for life support withdrawal. Ventilation liberation protocols are most often started and driven by respiratory therapists (40% and 90%); sedation started by residents (41%) and driven by nurses (95%); sepsis resuscitation started and driven by residents (49% and 46%); lung-protective ventilation started by attending physicians (39%) and driven by respiratory therapists (67%); and life support withdrawal started by attending physicians (93%) and driven by nurses (47%). CONCLUSIONS: There is wide variation in clinical protocol availability among teaching hospitals. Further study of the effect of protocols on education is needed.
PURPOSE: Clinical protocols to standardize care may improve patient outcomes but worsen trainee education. Our objective was to determine the availability of clinical protocols in teaching medical intensive care units (ICUs). MATERIALS AND METHODS: We administered an electronic questionnaire regarding protocol availability in 5 specific clinical areas. All directors of adult medical ICUs in US teaching hospitals were eligible to participate. RESULTS: The response rate was 70%. Eighty-six percent of ICU directors reported availability of protocols for ventilation liberation, 73% for sedation, 62% for sepsis resuscitation, 60% for lung-protective ventilation, and 48% for life support withdrawal. Ventilation liberation protocols are most often started and driven by respiratory therapists (40% and 90%); sedation started by residents (41%) and driven by nurses (95%); sepsis resuscitation started and driven by residents (49% and 46%); lung-protective ventilation started by attending physicians (39%) and driven by respiratory therapists (67%); and life support withdrawal started by attending physicians (93%) and driven by nurses (47%). CONCLUSIONS: There is wide variation in clinical protocol availability among teaching hospitals. Further study of the effect of protocols on education is needed.
Authors: E Rivers; B Nguyen; S Havstad; J Ressler; A Muzzin; B Knoblich; E Peterson; M Tomlanovich Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: E W Ely; A M Baker; D P Dunagan; H L Burke; A C Smith; P T Kelly; M M Johnson; R W Browder; D L Bowton; E F Haponik Journal: N Engl J Med Date: 1996-12-19 Impact factor: 91.245
Authors: Patsy D Treece; Ruth A Engelberg; Lauren Crowley; Jeannie D Chan; Gordon D Rubenfeld; Kenneth P Steinberg; J Randall Curtis Journal: Crit Care Med Date: 2004-05 Impact factor: 7.598
Authors: Nicholas A Smyrnios; Ann Connolly; Mark M Wilson; Frederick J Curley; Cynthia T French; Stephen O Heard; Richard S Irwin Journal: Crit Care Med Date: 2002-06 Impact factor: 7.598
Authors: Nicole B Gabler; Sarah J Ratcliffe; Jason Wagner; David A Asch; Gordon D Rubenfeld; Derek C Angus; Scott D Halpern Journal: Am J Respir Crit Care Med Date: 2013-10-01 Impact factor: 21.405
Authors: Christopher W Seymour; Pratik P Pandharipande; Tyler Koestner; Leonard D Hudson; Jennifer L Thompson; Ayumi K Shintani; E Wesley Ely; Timothy D Girard Journal: Crit Care Med Date: 2012-10 Impact factor: 7.598
Authors: Naeem A Ali; David Gutteridge; Sajid Shahul; William Checkley; Jonathan Sevransky; Greg S Martin Journal: Open Access J Clin Trials Date: 2011-09-23
Authors: Jonathan E Sevransky; William Checkley; Phabiola Herrera; Brian W Pickering; Juliana Barr; Samuel M Brown; Steven Y Chang; David Chong; David Kaufman; Richard D Fremont; Timothy D Girard; Jeffrey Hoag; Steven B Johnson; Mehta P Kerlin; Janice Liebler; James O'Brien; Terence O'Keefe; Pauline K Park; Stephen M Pastores; Namrata Patil; Anthony P Pietropaoli; Maryann Putman; Todd W Rice; Leo Rotello; Jonathan Siner; Sahul Sajid; David J Murphy; Greg S Martin Journal: Crit Care Med Date: 2015-10 Impact factor: 7.598
Authors: Christopher R Dale; Delores A Kannas; Vincent S Fan; Stephen L Daniel; Steven Deem; N David Yanez; Catherine L Hough; Timothy H Dellit; Miriam M Treggiari Journal: Ann Am Thorac Soc Date: 2014-03