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01-12-2020 | Phlebothrombosis | Research

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Authors: Huaiwu He, Xudong Ma, Longxiang Su, Lu Wang, Yanhong Guo, Guangliang Shan, Hui Jing He, Xiang Zhou, Dawei Liu, Yun Long, Yupei Zhao, Shuyang Zhang, China-NCCQC group

Published in: Critical Care | Issue 1/2020

Abstract

Introduction

Patient safety and critical care quality remain a challenging issue in the ICU. However, the effects of the national quality improvement (QI) program remain unknown in China.

Methods

A national ICU QI program was implemented in a controlled cohort of 586 hospitals from 2016 to 2018. The effects of the QI program on critical care quality were comprehensively investigated.

Main results

A total of 81,461,554 patients were enrolled in 586 hospitals, and 1,587,724 patients were admitted to the ICU over 3 years. In 2018, there was a significantly higher number of ICU beds (2016 vs. 2018: 10668 vs. 13,661, P = 0.0132) but a lower doctor-to-bed ratio (2016 vs. 2018: 0.64 (0.50, 0.83) vs. 0.60 (0.45, 0.75), P = 0.0016) and nurse-to-bed ratio (2016 vs. 2018: 2.00 (1.64, 2.50) vs. 2.00 (1.50, 2.40), P = 0.031) than in 2016. Continuous and significant improvements in the ventilator-associated pneumonia (VAP) incidence rate, microbiology detection rate before antibiotic use and deep vein thrombosis (DVT) prophylaxis rate were associated with the implementation of the QI program (VAP incidence rate (per 1000 ventilator-days), 2016 vs. 2017 vs. 2018: 11.06 (4.23, 22.70) vs. 10.20 (4.25, 23.94) vs. 8.05 (3.13, 17.37), P = 0.0002; microbiology detection rate before antibiotic use (%), 2016 vs. 2017 vs. 2018: 83.91 (49.75, 97.87) vs. 84.14 (60.46, 97.24) vs. 90.00 (69.62, 100), P < 0.0001; DVT prophylaxis rate, 2016 vs. 2017 vs. 2018: 74.19 (33.47, 96.16) vs. 71.70 (38.05, 96.28) vs. 83.27 (47.36, 97.77), P = 0.0093). Moreover, the 6-h SSC bundle compliance rates in 2018 were significantly higher than those in 2016 (6-h SSC bundle compliance rate, 2016 vs. 2018: 64.93 (33.55, 93.06) vs. 76.19 (46.88, 96.67)). A significant change trend was not found in the ICU mortality rate from 2016 to 2018 (ICU mortality rate (%), 2016 vs. 2017 vs. 2018: 8.49 (4.42, 14.82) vs. 8.95 (4.89, 15.70) vs. 9.05 (5.12, 15.80), P = 0.1075).

Conclusions

The relationship between medical human resources and ICU overexpansion was mismatched during the past 3 years. The implementation of a national QI program improved ICU performance but did not reduce ICU mortality.

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Title: Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals
Authors: Huaiwu He
Xudong Ma
Longxiang Su
Lu Wang
Yanhong Guo
Guangliang Shan
Hui Jing He
Xiang Zhou
Dawei Liu
Yun Long
Yupei Zhao
Shuyang Zhang
China-NCCQC group
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Phlebothrombosis
Published in: Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-020-2790-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Abstract

Introduction

Methods

Main results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Main results

Conclusions

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