Optimized Admission to the Intensive Care Unit by Using Crisis Resource Management (CRM)

Study Overview
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Brief Summary
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Admission to the intensive care unit (ICU) is vital for surviving critical illness. An admission to ICU without having a consistent structure, structured review of the patient and a solid team organization lead to unclear communication and responsibility. Factors that correlate with patient acceptance and safety, morbidity and mortality. The hypothesize was that a structured admission can improve patients safety, reduce delays in treatment, reduce ICU length of stay, and improve mortality rate. The overall objective was to optimize patient safety, and effectively use available resources to reduce admission time, delays in treatment and procedures and mortality by using both quantitative and qualitative methods.

Detailed Description
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The quantitative before-data is a one-year observational period prior to the intervention measured by different perspectives; patients and staff outcomes. After the intervention, was qualititive data collected from participants, who received simulation training. The quantitative after-data is a one-year observational period post-intervention with same outcomes as before starting the intervention. Data is already collected registry data from hospital quality assurance board. Data will be compared before and after with assessor blinded analysis. Missing data will not be replaced but reported as missing. The investigators will try to compare the results with data from an approximately comparative ICU in Denmark due to the implementation of a new patient management system called the Health Portal. The statistical analysis plan is based on descriptive and comparative analyses of the group before and after the trial. The quantitative results are explained in in-depths description from participants.

Official Title
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Optimized Admission to the Intensive Care Unit by Using Crisis Resource Management (CRM)

Conditions
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Critical Illness

Intervention / Treatment
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* Behavioral: Structured admission procedure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ICU admissions Exclusion Criteria: None Drop-out are deaths
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Before and after interventional study
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Structured Admission procedure<br>After implementation of a structured admission procedure to all ICU patients inspired by principles of Crisis Resource Management, Closed loop communication, action cards, and staff simulation training | Behavioral: Structured admission procedure<br>* A structured ICU admission was inspired by principles of Crisis Resource Management and simulation training of ICU staff members. The Principles of Crisis Resource Management consisted of a treatment manual, a learning video, clear precise communication tool based on Identification-Situation-Background-Analysis-Recommendations (ISBAR) and Closed loop, actions cards, and ABCDE-evaluation of the patient including debriefing, and training in the simulation environment.<br>* Other names: Standard Care;|
| No Intervention: Standard Care<br>Randomly admission procedure to all ICU patients based on the clinicians' evaluation prior implementation of the intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU length of stay (LOS) | Days admitted at the ICU using registre data | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay (LOS) | Days admitted to the hospital using registre data | At Hospital discharge within one-year before and after the intervention implementation | 
| Line Sepsis | Treatment package of number of the line sepsis after ICU admission covering the number of patients with line sepsis using registre data on Lactat <1 hour, bacteria samples ≤1 hour taken, time between diagnosis of sepsis and taken bacteria samples, time between diagnosis and given antibiotics measured by registre data | through study completion, an average of 1 year | 
| Ventilated associated pneumonia (VAP) | Number of VAP measured by registre data | through study completion, an average of 1 year | 
| Re-intubations | Number of re-intubations measured by registre data | through study completion, an average of 1 year | 
| 30-days Mortality | 30-days mortality rates after ICU discharge measured by registre data | 30 days through study completion, an average of 1 year | 
| 90-days Mortality | 90-days mortality rates after ICU discharge measured by registre data | 90 days through study completion, an average of 1 year | 
| Staff turn-over | Staff turn-over before and after the intervention measured by registre data | through study completion, an average of 1 year | 
| Sick Leave | Sick leave amongst staff members measured by registre data | through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intensive care, crisis resource management, simulation training, before and after study