The effect of a managerial-based intervention on the occurrence of out-of-range-measurements and mortality in Intensive Care Units

Purpose: To evaluate the effect of an organization-based managerial intervention on performance of intensive care units (ICUs).Methods and Participants: Prospective multicentre cluster-randomized study with an intervention at the level of ICU staff was carried out. The intervention comprised a set of managerial changes, concerning the nurses' level of skill discretion and participation in decision-making introduced during a period of six months. The ICU-performance was monitored before, during and after the intervention, in terms of mortality and occurrence of out-of-range-measurements (ORMs). The ORMs were defined as a derangement of systolic blood pressure (BP), heart rate (HR), oxygen saturation (SaO(2)) and urine output (Diur). Data were statistically analyzed by logistic regression with random effects due to ICUs.Results: The overall ICU and hospital mortalities were 14% and 20%, the incidence of BP, HR, O2 and Diur ORM was respectively 46%, 38%, 28% and 48%. After adjusting for SAPSII, admission type and age the regression analyses revealed a positive effect of the intervention for all the six outcome variables.Conclusions: The intervention reduced both the ICU and hospital mortalities and the incidences of the out-of-range measurements. Registering ORMs provides a feasible method for evaluating ICU performance and could help to optimize individual patient care. (C) 2004 Elsevier Inc. All rights reserved.