Introducing a new sedation policy in a large district general hospital: before and after cohort analysis

Background
The management of pain, agitation and sedation for ventilated patients who are admitted to intensive care is an essential part of their care. The introduction of sedation protocols is associated with improved patient outcomes.

Methods
We conducted an observational cohort study among mechanically ventilated patients in a 16-bed ICU over a two-year period. We retrospectively examined data from two patient populations, namely those before and after the introduction of a new sedation protocol in July 2015. The primary outcome was the duration of mechanical ventilation in both groups.

Results
After the implementation of the new sedation protocol, there was a significant decrease in the mean duration of mechanical ventilation (1.45 days). Furthermore, we observed a non-significant reduction in the mean duration of ICU stay.

Conclusion
The new protocol was associated with outcome improvements including: decreased mean duration of mechanical ventilation and a reduced number of ventilated days; and increased patient throughput with a slight increase in the length of vasopressor support. Moreover, the use of a structure-process-outcome model of quality improvement was associated with significant improvements in process measures of quality.