Trial reportImplementation science : IS2015
A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care.
Trial report in Implementation science : IS, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2026Pooled it
- Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial.BMJ quality & safety · 2019Trial
- Reporting feedback on healthcare outcomes to improve quality in care: a scoping review.Implementation science : IS · 2025Article
- [Quality indicators in intensive care medicine : Background and practical use].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2021Review
- Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.Implementation science : IS · 2021Article
- Process evaluation of the effects of patient safety auditing in hospital care (part 2).International journal for quality in health care : journal of the International Society for Quality in Health Care · 2019Article
- Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial.Implementation science : IS · 2017Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundOrganizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.
methodsIn a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.
resultsWe analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62-1.27) or compared to control group (OR 0.67; 95 % CI 0.39-1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41-1.26 compared to baseline and OR 0.65; 95 % CI 0.35-1.19 compared to control group).
conclusionsA multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.
trial registrationISRCTN: ISRCTN50542146.
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