Improving care for the ventilated patient

Jt Comm J Qual Saf. 2004 Apr;30(4):195-204. doi: 10.1016/s1549-3741(04)30021-3.


Context: Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis.

Intervention: The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes, (2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies.

Results: Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4-April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (p < .001).

Discussion: Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Baltimore
  • Cohort Studies
  • Evidence-Based Medicine
  • Guideline Adherence
  • Health Services Research
  • Humans
  • Intensive Care Units / standards*
  • Joint Commission on Accreditation of Healthcare Organizations
  • Outcome and Process Assessment, Health Care
  • Prospective Studies
  • Quality Assurance, Health Care / methods*
  • Respiration, Artificial / standards*
  • Surveys and Questionnaires
  • United States