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Incorporation of Daily Goals in Daily Care Planning Does Not Shorten Length of Stay in the Intensive Care Unit

Binnekade, Jan, M., PhD; Brunsveld-Reinders, Anja, H., PhD; Arbous, M., Sesmu, MD, PhD; Dijkgraaf, Marcel G., W., PhD; Horn, Janneke, MD, PhD; van der Sloot, Jos A., P., MD, PhD; Balzereit, Anja, MD, PhD; Schultz, Marcus, J., MD, PhD; Brinkman, Sylvia, PhD; Vroom, Margreeth, B., MD, PhD

doi: 10.1097/CNQ.0000000000000197
Original Articles

A strategy of defining and checking explicitly formulated patient-specific treatments targets or “daily goals” in the intensive care unit has been associated with improved communication. We investigated the effect of incorporation of daily goals into daily care planning on length of stay in the intensive care unit. Furthermore, the type of daily goals and deviations from daily goals in daily care with or without documented reason were evaluated. Four university hospitals in the Netherlands, of which 2 study “daily goal” hospitals and 2 control hospitals, participated in a prospective before-after study. During the before phase of the study, daily goals were formulated by the attending physician but kept blinded from doctors and nurses caring for the patient. During the after phase of the study, daily goals were integrated in the care plan for patients admitted to the 2 study hospitals but not for patients admitted to the control hospitals. The implementation of daily goals was, after case-mix correction, not associated with a change in intensive care unit length of stay. However, this study showed that an improved administrative discipline, that is, the recording of the reason why a daily goal or standard protocol was not accomplished, is in favor of the daily goal implementation.

Departments of Intensive Care (Drs Binnekade, Horn, van der Sloot, Schultz, and Vroom), Epidemiology and Biostatistics (Dr Dijkgraaf), and Medical Informatics (Dr Brinkman), Academic Medical Center, Amsterdam, the Netherlands; Departments of Intensive Care (Drs Brunsveld-Reinders, Arbous, and Balzereit) and Clinical Epidemiology (Dr Arbous), Leiden University Medical Center, Leiden, the Netherlands; and NICE Foundation, Amsterdam, the Netherlands (Drs Arbous and Brinkman).

Correspondence: Jan M. Binnekade, PhD, Department of Intensive Care, C3-323, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, the Netherlands (

The authors thank Dr R. Holman from the “National Intensive Care Evaluation” for help and advice in analyzing the data.

The study was financed and endorsed by The Dutch Organisation for Health Research and Development (Zorgonderzoek Medische Wetenschappen, ZonMW, The Hague, the Netherlands) that had no influence on study design, data analysis, or reporting.

The following authors contributed to the article: J. M. Binnekade had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; study concept and design: Binnekade, Arbous, Dijkgraaf, Vroom, and Schultz; analysis and interpretation of the data: Binnekade, Arbous, Brinkman, and Vroom; drafting of the manuscript: Binnekade, Brunsveld-Reinders, Arbous, Dijkgraaf, and Vroom; critical revision of the manuscript for important intellectual content: Brunsveld-Reinders, Arbous, Dijkgraaf, Horn, Sloot, Balzereit, and Vroom; statistical analysis: Binnekade; and obtained funding: Binnekade, Arbous, Dijkgraaf, Horn, and Vroom.

All authors have declared no conflicts of interest.

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