Quality Improvement Interventions in Intensive Care Units

Abstract

To the Editor: Dr Scales and colleagues reported that quality improvement interventions increased adoption of some (but not all) care processes in community intensive care units (ICUs) in Ontario. They noted that the ICU interprofessional team approach to patient care is well accepted, but we question whether the educational needs and methods of delivering the intervention were the same for physicians, nurses, respiratory therapists, and others. In our ICU, many nurses review educational materials about new unit practices or devices assigned by their nurse managers when they do not have patient care responsibilities. Learning these materials is part of the job, and they are held accountable by their employer, the hospital. Physicians rarely do something similar during their clinical workday. Physician education is done away from work at specific continuing medical education opportunities and is generally tied to state medical licensure and national board-certification requirements. The content presented is rarely specific to the hospital at which they work. Did the authors tailor the educational intervention to the type of clinician who would likely have the greatest responsibility for the process—ie, nurses for decubitus ulcer risk measurement, respiratory therapists for daily weaning trials, or physicians for catheter infection prevention? Differences in learning styles based on training experience and expectations about what constitutes continuing education might explain the variation in adoption by ICUs of lifesaving practices.