Intensive care unit capacity strain and adherence to prophylaxis guidelines

Area of Science:

• Critical Care Medicine
• Healthcare Management
• Patient Safety

Background:

• Intensive care units (ICUs) face capacity strain, impacting clinical practice.
• Adherence to evidence-based prophylaxis guidelines is crucial for patient outcomes.
• Understanding factors influencing guideline adherence is essential for quality improvement.

Purpose of the Study:

• To investigate the association between ICU capacity strain and adherence to venous thromboembolism prophylaxis (VTEP) and stress ulcer prophylaxis (SUP) guidelines.
• To explore how different measures of capacity strain affect the utilization of VTEP and SUP.
• To identify potential differences in the impact of strain on prophylaxis use across various ICU structures.

Main Methods:

• Retrospective cohort study utilizing the Project IMPACT database.
• Multivariable logistic regression analysis to assess relationships between capacity strain metrics and prophylaxis use.
• Examination of capacity strain defined by new admissions and census, and its impact on VTEP and SUP.

Main Results:

• Appropriate VTEP was administered in 68% of eligible patient-days; appropriate SUP in 48%.
• Increased ICU capacity strain, measured by new admissions and census, was associated with decreased odds of receiving VTEP.
• The negative impact of strain on VTEP utilization was more pronounced in ICUs with closed staffing models compared to open models.

Conclusions:

• Rising ICU capacity strain significantly reduces the likelihood of appropriate VTEP administration.
• Capacity strain did not significantly affect the administration of SUP.
• Variability in VTEP use degradation across different ICU types highlights opportunities for targeted system improvements to mitigate strain's impact.