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Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units*

Leone, Marc MD, PhD; Ragonnet, Benoit MD; Alonso, Sandrine MS; Allaouchiche, Bernard MD, PhD; Constantin, Jean-Michel MD, PhD; Jaber, Samir MD, PhD; Martin, Claude MD, FCCM; Fabbro-Peray, Pascale MD, PhD; Lefrant, Jean-Yves MD, PhD

doi: 10.1097/CCM.0b013e31826571f2
Clinical Investigations

Objective: Clinical guidelines should provide a framework for managing patients hospitalized in intensive care units. Little is known about guideline compliance in real-life practice. To evaluate compliance rates for a large bundle of intensive care unit practice guidelines and determine factors associated with noncompliance to these guidelines.

Design, Setting, and Patients: A bundle of 13 clinical guidelines was elaborated by a group of senior physicians. Four external consultants validated the process. Then, a 1-day audit was performed at 66 participating adult intensive care units in 39 institutions by a group of 64 junior investigators supervised by senior intensivists. At the bedside, investigators collected data from 625 patients hospitalized in those units.

Interventions and Measurements: The eligibility and compliance rates were determined for each clinical recommendation. The rate of full compliance to each eligible clinical guideline was calculated. Mortality data were requested 28 days after the completion of the audit.

Main Results: The eligibility rate ranged from 11% (sepsis bundle) to 80% (identified closest relative). The median compliance rate was 75% (60–100), ranging from 24% (sedation monitoring) to 96% (identified closest relative and bacteriological sampling before initiating antibiotics). Our results showed that only 24% (20–27) of patients in our cohort received fully compliant care. The 28-day survival probability was .77 (.73–.80).

Conclusions: At the bedside, clinical guidelines are fully applied in 24% of patients. Our study underlines the need to both improve the process of implementation and become cognizant of excessive proliferation of clinical guidelines.

From the Service d’Anesthésie et de Réanimation (ML, BR, CM), Hôpital Nord, Aix-Marseille Univ, Marseille, France; Service de Biostatistiques, Epidémiologie, Santé Publique et Information Médicale (SA, PF-P), Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de Nîmes, Nîmes, France; Service d’Anesthésie et de Réanimation (BA), Hôpital de la Croix Rousse, Lyon, France; Service d’Anesthésie Réanimation (J-MC), Hôpital Hôtel Dieu, Clermont-Ferrand, France; Service d’Anesthésie Réanimation A (SJ), CHU Saint Eloi, Montpellier, France; and Division Anesthésie Réanimation Douleur Urgences (J-YL), Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.

*See also p. 3317.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/ccmjournal).

Members of the AzuRéa Group are listed in Appendix 2.

This work was funded by the “Division Anesthésie Réanimation Douleur Urgences,” Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.

Portions of this work were presented at the Annual Meeting of the French Society of Anesthesiology and Critical Care Medicine, September 22, 2010.

Drs. Allaouchiche, Constantin, Lefrant, Leone, and Jaber conceived and designed the study. Drs. Lefrant, Leone, and Ragonnet performed the investigation. Mr. Alonso and Drs. Lefrant, Leone, Fabbro-Peray, and Ragonnet contributed analysis tool. Drs. Allaouchiche, Constantin, Lefrant, Leone, Martin, Fabbro-Peray, and Jaber analyzed the data. Drs. Lefrant, Leone, Martin, Fabbro-Peray, and Ragonnet wrote the article. Dr. Fabbro-Peray has full access to original data.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: marc.leone@ap-hm.fr

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins