Document Detail

The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU.
MedLine Citation:
PMID:  23314584     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine if a quality improvement intervention improves sleep and delirium/cognition.
DESIGN: Observational, pre-post design.
SETTING: A tertiary academic hospital in the United States.
PATIENTS: 300 medical ICU patients.
INTERVENTIONS: This medical ICU-wide project involved a "usual care" baseline stage, followed by a quality improvement stage incorporating multifaceted sleep-promoting interventions implemented with the aid of daily reminder checklists for ICU staff.
MEASUREMENTS AND MAIN RESULTS: Primary ICU outcomes were perceived sleep quality and noise ratings (measured on a 0-100 scale using the valid and reliable Richards-Campbell Sleep Questionnaire) and delirium/coma-free days. Secondary outcomes included ICU and hospital length of stay and mortality. Post-ICU measures of cognition and perceived sleep quality were evaluated in an ICU patient subset. During the baseline and sleep quality improvement stages, there were 122 and 178 patients, respectively, with more than one night in the ICU, accounting for 634 and 826 patient-days. Within the groups, 78 (63.9%) and 83 (46.6%) patients received mechanical ventilation. Over the 826 patient-day quality improvement period, checklist item completion rates ranged from 86% to 94%. In multivariable regression analysis of the quality improvement vs. baseline stages, improvements in overall Richards-Campbell Sleep Questionnaire sleep quality ratings did not reach statistical significance, but there were significant improvements in daily noise ratings (mean ± SD: 65.9±26.6 vs. 60.5±26.3, p = 0.001), incidence of delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23-0.89; p = 0.02), and daily delirium/coma-free status (odds ratio: 1.64; 95% confidence interval, 1.04-2.58; p = 0.03). Improvements in secondary ICU outcomes and post-ICU outcomes did not reach statistical significance.
CONCLUSIONS: An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
Biren B Kamdar; Lauren M King; Nancy A Collop; Sruthi Sakamuri; Elizabeth Colantuoni; Karin J Neufeld; O Joseph Bienvenu; Annette M Rowden; Pegah Touradji; Roy G Brower; Dale M Needham
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-21     Completed Date:  2013-04-16     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  800-9     Citation Subset:  AIM; IM    
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MeSH Terms
Delirium / physiopathology
Intensive Care Units*
Middle Aged
Noise, Occupational
Outcome Assessment (Health Care) / methods
Qualitative Research
Quality Improvement*
Grant Support
Comment In:
Crit Care Med. 2013 Mar;41(3):922-3   [PMID:  23425830 ]

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