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Baseline (preintervention period) characteristics of hospitals and patients ventilated for more than 24 hours
Source publication
Background
Although clinical peer review is a well-established instrument for improving quality of care, clinical effectiveness is unclear.
Methods
In a pragmatic cluster randomised controlled trial, we randomly assigned 60 German Initiative Qualitätsmedizin member hospitals with the highest mortality rates in ventilated patients in 2016 to interv...
Citations
... In an attempt to determine the utility of peer review, Schmitt et al 14 in this edition of the journal performed a cluster randomised trial of 60 hospitals, nested within the German 'Initiative Qualitätsmedizin' (IQM), a voluntary national multiprofessional quality improvement collaboration established in 2009 involving 385 hospitals. The population they chose for review was intensive care unit patients receiving mechanical ventilation for >24 hours. ...
The privilege of professional self-regulation rests on clinical peer review, a long-established method for assuring quality of care, training, management and research. In clinical peer review, healthcare professionals evaluate each other's clinical performance. Based originally on the personal experience and expertise (and prejudices and biases) of one's peers, the process has gradually been formalised by the development of externally verifiable standards of practice, audit of care processes and outcomes and benchmarking of individual, group and organisational performance and patient outcomes. The spectrum of clinical peer review ranges from local quality improvement activities such as morbidity and mortality reviews, to medical opinion offered in courts of law. Peer review can therefore have different purposes ranging from collaborative reflective learning to identification of malpractice. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
... Details, baseline, explorative and confirmatory results of the IMPRESS study were published previously. [15][16][17][18] The study has been registered at ISCRTN. 19 The identification of possible covariates of mortality and non-mortality outcomes in colorectal resections was a secondary aim of the IMPRESS study. ...
Objectives
Studies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups is still scarce. Therefore the aim of this analysis was to investigate consistent relationships between multiple patient safety outcomes, healthcare and hospital risk factors in colorectal resection cases.
Design
Cross-sectional study.
Setting
German inpatient routine care data of colorectal resections between 2016 and 2018.
Participants
We analysed 54 168 colon resection and 20 395 rectum resection cases treated in German hospitals. The German Inpatient Quality Indicators were used to define colon resections and rectum resections transparently.
Primary outcome measures
Additionally to in-hospital death, postoperative respiratory failure, renal failure and postoperative wound infections we included multiple patient safety outcomes as primary outcomes/dependent variables for our analysis. Healthcare (eg, weekend surgery), hospital (eg, volume) and case (eg, age) characteristics served as independent covariates in a multilevel logistic regression model. The estimated regression coefficients were transferred into ORs.
Results
Weekend surgery, emergency admissions and transfers from other hospitals were significantly associated (ORs ranged from 1.1 to 2.6) with poor patient safety outcome (ie, death, renal failure, postoperative respiratory failure) in colon resections and rectum resections. Hospital characteristics showed heterogeneous effects. In colon resections hospital volume was associated with insignificant or adverse associations (postoperative wound infections: OR 1.168 (95% CI 1.030 to 1.325)) to multiple patient safety outcomes. In rectum resections hospital volume was protectively associated with death, renal failure and postoperative respiratory failure (ORs ranged from 0.7 to 0.8).
Conclusions
Transfer from other hospital and emergency admission are constantly associated with poor patient safety outcome. Hospital variables like volume, ownership or localisation did not show consistent relationships to patient safety outcomes.
Trial registration number
ISRCTN10188560 .
