The availability of clinical protocols in US teaching intensive care units

J Crit Care. 2010 Dec;25(4):610-9. doi: 10.1016/j.jcrc.2010.02.014. Epub 2010 Apr 8.


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.

MeSH terms

  • Clinical Competence
  • Clinical Protocols*
  • Critical Care / standards*
  • Education, Medical*
  • Hospitals, Teaching / organization & administration*
  • Humans
  • Intensive Care Units / organization & administration*
  • Practice Guidelines as Topic
  • Surveys and Questionnaires
  • United States