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[Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy].

ABSTRACT: To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process.A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff training.Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in the post-intervention period with a total of 1246 and 1191 observations respectively. Among the indicators related to the global population, there was a significant improvement in chest x-ray control, multidisciplinary rounds and shift changes as well as in compliance with these decisions. Indicators related to the population under mechanical ventilation, obtained by direct observation at bedside, showed a significant improvement in the compliance with the tidal volume of 6-8 mL/Kg, plateau pressure <30 cmH₂O, adequate mechanical ventilation alarm setting, mechanical ventilation humidification control, adequate humidification line exchange and orotracheal tube position. Among the mechanical ventilation indicators collected through the physiotherapy records, there was significantly improved compliance with the predicted tidal volume registry and cuff pressure registry. There was a significant reduction in the number of adverse events. There was no impact on intensive care unit mortality, length of stay, duration of mechanical ventilation and ventilator-free days.It is possible to measure the quality of physiotherapy care using indicators of quality control. The implementation of care protocols and training of the professionals can improve team performance.

SUBMITTER: Pinto WA

PROVIDER: S-EPMC4031892 | biostudies-other | 2014 Jan-Mar

REPOSITORIES: biostudies-other

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Project description:BackgroundLimited critical care subspecialty training and experience is available in many low- and middle-income countries, creating barriers to the delivery of evidence-based critical care. We hypothesized that a structured tele-education critical care program using case-based learning and ICU management principles is an efficient method for knowledge translation and quality improvement in this setting.Methods and interventionsWeekly 45-min case-based tele-education rounds were conducted in the recently established medical intensive care unit (MICU) in Banja Luka, Bosnia and Herzegovina. The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) was used as a platform for structured evaluation of critically ill cases. Two practicing US intensivists fluent in the local language served as preceptors using a secure two-way video communication platform. Intensive care unit structure, processes, and outcomes were evaluated before and after the introduction of the tele-education intervention.ResultsPatient demographics and acuity were similar before (2015) and 2 years after (2016 and 2017) the intervention. Sixteen providers (10 physicians, 4 nurses, and 2 physical therapists) evaluated changes in the ICU structure and processes after the intervention. Structural changes prompted by the intervention included standardized admission and rounding practices, incorporation of a pharmacist and physical therapist into the interprofessional ICU team, development of ICU antibiogram and hand hygiene programs, and ready access to point of care ultrasound. Process changes included daily sedation interruption, protocolized mechanical ventilation management and liberation, documentation of daily fluid balance with restrictive fluid and transfusion strategies, daily device assessment, and increased family presence and participation in care decisions. Less effective (dopamine, thiopental, aminophylline) or expensive (low molecular weight heparin, proton pump inhibitor) medications were replaced with more effective (norepinephrine, propofol) or cheaper (unfractionated heparin, H2 blocker) alternatives. The intervention was associated with reduction in ICU (43% vs 27%) and hospital (51% vs 44%) mortality, length of stay (8.3 vs 3.6 days), cost savings ($400,000 over 2 years), and a high level of staff satisfaction and engagement with the tele-education program.ConclusionsWeekly, structured case-based tele-education offers an attractive option for knowledge translation and quality improvement in the emerging ICUs in low- and middle-income countries.

Project description:ObjectivesTo describe spinal pain patients referred by their treating general practitioners to physiotherapy care, examine to which extent physiotherapy interventions proposed by general practitioners and physiotherapists were compliant to evidence based recommendations, and evaluate concordance between providers in terms of diagnosis and contraindications to physiotherapy interventions.MethodsThis study included spinal pain patients recruited from a random sample of sixty French physiotherapists. Physiotherapists were asked to supply patients' physiotherapy records and characteristics from the general practitioner's physiotherapy referral for the five new consecutive patients referred to physiotherapy. General practitioner's physiotherapy referral and physiotherapists' clinical findings characteristics were analyzed and compared to evidence-based recommendations using Chi-squared tests. Cohen's kappas were calculated for diagnosis and contraindications to physiotherapy interventions.ResultsThree hundred patients with spinal pain were included from sixty physiotherapists across France. The mean age of the patients was 48.0 ± 7.2 years and 53% were female. The most common spinal pain was low back pain (n = 147). Diagnoses or reason of referral formulated by general practitioners were present for 27% of all patients (n = 82). Compared to general practitioners, physiotherapists recommended significantly more frequently recommended interventions such as education, spinal exercises or manual therapy. General practitioners prescribed significantly more frequently passive physiotherapy approaches such as massage therapy and electrotherapy. The overall proportion of agreement beyond chance for identification of a diagnosis or reason of referral was 41% with a weak concordance (κ = 0.19; 95%CI: 0.08-0.31). The overall proportion of compliant physiotherapists was significantly higher than for general practitioners (76.7% vs 47.0%; p<0.001).ConclusionsWe found that information required for the referral of spinal pain patients to physiotherapy is often incomplete. The majority of general practitioners did not conform to evidence-based recommendations in terms of prescribed specific physiotherapy care; in contrast to a majority of physiotherapists.Trial registrationClinicalTrials.gov: NCT04177121.

Project description:Abstract Objectives The goal of the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is to assist low-income households to improve diet quality. The objective of this study was to evaluate the long-term effects of SNAP-Ed nutrition education lessons on diet quality and key nutrient and food group outcomes among Indiana SNAP-Ed-eligible adults. Methods The study design was a parallel-arm randomized controlled nutrition education intervention. The intervention consisted of the first 4 lessons of the Indiana adult SNAP-Ed curriculum delivered to participants during the 4 to 10 weeks after their baseline assessment. Participants (≥18 yrs) eligible for SNAP-Ed and interested in receiving nutrition education lessons (direct SNAP-Ed) were recruited from 31 Indiana counties (N = 261) and completed baseline assessments from August 2015 to May 2016. Follow-up assessments were conducted approximately 1-year after baseline from August 2016 to May 2017 (n = 103). Dietary intake was assessed using up to 2 24-hour dietary recalls at each assessment time point. The main outcome measures were mean usual nutrient (calcium; vitamins D, A, C, E; magnesium; folate; potassium; fiber; dairy; fruit; vegetable; whole grains) the proportion meeting Estimated Average Requirements, exceeding Adequate Intakes, or meeting daily recommended servings, and diet quality as measured by the Healthy Eating Index-2010. This study is registered at www.clinicaltrials.gov as NCT03436784. Significance was P ≤ 0.05. Analyses were completed using SAS 9.4. Results No effect of direct SNAP-Ed was found on diet quality, nutrient, or food group intake in the treatment compared to the control group between baseline and the 1-year follow-up assessment (P > 0.05). Conclusions Direct SNAP-Ed did not improve long-term diet quality, nutrient, or food group intake among Indiana SNAP-Ed eligible adults. Funding Sources Funding for this research was provided by Purdue University as part of AgSEED Crossroads funding to support Indiana's Agriculture and Rural Development, Purdue University Frederick N. Andrews Fellowship, Purdue University Center for Families Justice Family Nutrition Award, the Purdue University Nutrition Education Program, and a USDA NIFA Hatch Project.

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[Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy].

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