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Organisational characteristics associated with the use of daily interruption of sedation in US hospitals: a national study
  1. Melissa A Miller1,
  2. Sarah L Krein2,3,
  3. Sanjay Saint4,
  4. Jeremy M Kahn5,
  5. Theodore J Iwashyna1
  1. 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, Michigan, USA
  3. 3Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Department of Internal Medicine, Ann Arbor VA Medical Center & University of Michigan Medical School, Ann Arbor, Michigan, USA
  5. 5Department of Critical Care Medicine and Health Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Melissa A Miller, Clinical Lecturer, Pulmonary and Critical Care Medicine, University of Michigan, 1500 E. Medical Center Drive, TC 3916, Ann Arbor, MI 48109-5360, USA; melmille{at}umich.edu

Abstract

Objective Daily interruption of sedation (DIS) has multiple proven benefits, but implementation is erratic. Past research on sedative interruption utilisation focused on individual clinicians, ignoring the role of organisations in shaping practice. The authors test the hypothesis that specific hospital organisational characteristics are associated with routine use of DIS.

Design and setting National, mailed survey to a stratified random sample of US hospitals in 2009. Respondents were the lead infection control professionals at each institution.

Methods Survey items enquired about DIS use, institutional structure, and organisational culture. Multivariable analysis was used to evaluate the independent association of these factors with DIS use.

Results A total of 386 hospitals formed our final analytic sample; the response rate was 69.4%. Hospitals ranged in size from 25 to 1359 beds. 26% of hospitals were associated with a medical school. Almost 80% reported regular use of DIS for ventilated patients. While 75.4% of hospitals reported having leadership focus on safety culture, only 42.7% reported that their staff were receptive to changes in practice. In a multivariable logistic regression model, structural characteristics such as size and academic affiliation were not associated with use of DIS. However, leadership emphasis on safety culture (p=0.04), staff receptivity to change (p=0.02) and involvement in an infection prevention collaborative (p=0.04) were significantly associated with regular DIS use.

Conclusions Several elements of hospital organisational culture were associated with regular use of DIS in US hospitals. These findings emphasise the importance of combining specific administrative approaches with strategies to encourage receptivity to change among bedside clinicians in order to successfully implement complex evidence-based practices in the intensive care setting.

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Footnotes

  • Funding This study was supported by the National Institute of Health NIH/NHLBI T32: HL07749-17 (MAM) and K08: HL091249-03 (TJI), as well as by the Blue Cross Blue Shield of Michigan Foundation. The funding organisations were not involved with the study's design, conduct, or reporting.

  • Competing interests None.

  • Ethics approval This study was approved by the Institutional Review Board of the University of Michigan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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