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Breast Surgery

Monday 20 October 2008

Systems ambiguity and guideline compliance: a qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-asso

Gurses AP, Seidl KL, Vaidya V, Bochicchio G, Harris AD, Hebden J, Xiao Y.

Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA. gurse001@umn.edu

BACKGROUND: Consistent compliance with evidence-based guidelines is challenging yet critical to patient safety. We conducted a qualitative study to explore the underlying causes for non-compliance with evidence-based guidelines aimed at preventing four types of healthcare-associated infections in the surgical intensive care unit (SICU) setting.

METHODS: Twenty semistructured interviews were conducted with attending physicians (3), residents (2), nurses (6), quality improvement coordinators (3), infection control practitioners (2), respiratory therapists (2) and pharmacists (2) in two SICUs. Using a grounded theory approach, we performed thematic analyses of the interviews. RESULTS: The concept of systems ambiguity to explain non-compliance with evidence-based guidelines emerged from the data. Ambiguities hindering consistent compliance were related to tasks, responsibilities, methods, expectations and exceptions. Strategies reported to reduce ambiguity included clarification of expectations from care providers with respect to guideline compliance through education, use of visual cues to indicate the status of patients with respect to a particular guideline, development of tools that provide an overview of information critical for guideline compliance, use of standardised orders, clarification of roles of care providers and use of decision-support tools.

CONCLUSIONS: The concept of systems ambiguity is useful to understand causes of non-compliance with evidence-based guidelines aimed at reducing healthcare-associated infections. Multi-faceted interventions are needed to reduce different ambiguity types, hence to improve guideline compliance.

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Laterre P, Macias W, Janes J, Williams M, Nelson D, Girbes A, Dhainaut J, Abraham ECritical Care, 2008 12:R117 ( 11 September 2008 )[Abstract] [Provisional PDF] [PubMed]

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Readmission to a surgical intensive care unit: incidence, outcome, and risk factors

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Kaben A, Correa F, Reinhart K, Settmacher U, Gummert J, Kalff R, Sakr YCritical Care, 2008 12:R123 ( 6 October 2008 )[Abstract] [Provisional PDF]

Clinical review: Critical care in the global context – disparities in burden of illness, access, and economics

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Rachel G Khadaroo and John C Marshall

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Gisela Del Carmen De La Rosa ; Jorge Hern and o Donado ; Alvaro Humberto Restrepo ; et al
BioMed Central PDF Abstract
Free Medical Journals . com (/1997 - / Embargo: 2 years)
UK PubMed Central (/1997 - /2008)
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Rose , L . ; Redl , L .
EBSCO ( CINAHL with Full Text ) - via Athens Full Text (11/2002 - /)
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Page: 428-435 Vol/Issue: 2008 ; VOL 17 ; PART 5
ISSN Print: 1062-3264
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Chang , L . - Y . ; Wang , K . - W . K . ; Chao , Y . - F .
EBSCO ( CINAHL with Full Text ) - via Athens Full Text (11/2002 - /)
Free Medical Journals . com Proquest NHS (01/1998 - 05/2007)
Page: 408-416 Vol/Issue: 2008 ; VOL 17 ; PART 5
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Tight glycemic control does not affect asymmetric - dimethylarginine in septic patients

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Iapichino , Gaetano ; Albicini , Maura ; Umbrello , Michele ; Sacconi , Francesca ; Fermo , Isabella ; Pavlovich , Radmila ; Paroni , Rita ; Bellani , Giacomo ; Mistraletti , Giovanni ; Cugno , Massimo ; Pesenti , Antonio ; Gattinoni , Luciano
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Page: 1843-1850 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
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Page: 1835-1842 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
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Rose , Louise ; Presneill , Jeffrey ; Johnston , Linda ; Cade , John
Proquest NHS (01/2002 - 10/2007)
Page: 1788-1795 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
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Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients

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Blot , Franç ; ois ; Similowski , Thomas ; Trouillet , Jean - Louis ; Chardon , Patrick ; Korach , Jean - Michel ; Costa , Marie - Alyette ; Journois , Didier ; Thiâ ; ery , Guillaume ; Fartoukh , Muriel ; Pipien , Isabelle ; Bruder , Nicolas ; Orlikowski , David ; Tankere , Frâ ; edâ ; eric ; Dur and - Zaleski , Isabelle ; Auboyer , Christian ; Nitenberg , Gâ ; erard ; Holzapfel , Laurent ; Tenaillon , Alain ; Chastre , Jean ; Laplanche , Agná ; es
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Airway pressure release ventilation and biphasic positive airway pressure : a systematic review of definitional criteria

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Rose , Louise ; Hawkins , Martyn
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Page: 1766-1773 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
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Laghi , Franco
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Page: 1746-1748 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
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Tracheostomy timing , enrollment and power in ICU clinical trials

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Scales , Damon ; Kahn , Jeremy
Proquest NHS (01/2002 - 10/2007)
Page: 1743-1745 Vol/Issue: 2008 ; VOL 34 ; PART 10 Date: 2008/10/01
ISSN Print: 0342-4642 E-ISSN: 1432-1238
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