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Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
  1. Robyn Clay-Williams1,
  2. Brette Blakely2,
  3. Paul Lane3,
  4. Siva Senthuran3,
  5. Andrew Johnson3
  1. 1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  2. 2 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  3. 3 Townsville Hospital and Health Service, Townsville, Queensland, Australia
  1. Correspondence to Dr Robyn Clay-Williams; robyn.clay-williams{at}mq.edu.au

Abstract

Objective To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.

Design Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.

Setting ICU in a 700-bed regional tertiary care hospital in Australia.

Participants 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.

Intervention Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan.

Main outcome measures Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds.

Results Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ2 1=24.9, p<0.0001.

Conclusions By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.

  • organisation of health services
  • intensive care

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Footnotes

  • Contributors RC-W, PL, SS and AJ contributed to the conception and design of the study; RC-W and BB collected, analysed and interpreted the study data; RC-W and BB drafted the manuscript, and PL, SS and AJ revised it critically for intellectual content; all authors approved the final version of the paper.

  • Funding Financial support for this study was provided in part by a small grant from the Townsville Hospital and Health Service Research Trust Fund. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report.

  • Competing interests PL, SS and AJ were involved in development of the intervention; however, they were not interviewed as part of the study and were not involved in data collection or analysis. The authors have no other competing interests to declare.

  • Ethics approval Ethics approval for the study was obtained from XX Human Research Ethics Committee (HREC/14/QTHS/117).

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

  • Data sharing statement Data available from the corresponding author on request.

  • Patient consent for publication Not required.

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