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May 4, 2011

Quality Improvement Interventions in Intensive Care Units—Reply

JAMA. 2011;305(17):1764-1765. doi:10.1001/jama.2011.559

In Reply: Drs Nagamatsu and Weinert note that learning styles vary depending on the role and training of health care workers in the ICU. In our quality improvement initiative, we did not modify the educational interventions based on health care worker discipline (ie, physicians, nurses, or respiratory therapists), choosing instead to provide a variety of education and dissemination tools for each targeted care practice.1,2 Our approach allowed members of the interdisciplinary ICU team to select their method of receiving continuing health education. For example, we provided lectures via videoconferencing for clinicians preferring interactive discussions; these were also available for later Web-based viewing for clinicians who preferred to learn on their own time. Similarly, we provided summary sheets outlining key facts for busy clinicians but also provided detailed literature reviews and guidelines for those wanting additional information. We did, however, tailor the reminder tools to specific types of clinicians. For example, we designed stamps for the medical record to help respiratory therapists document the outcome of spontaneous breathing trials and improve communication with physicians, and we provided pocket cards outlining the Braden scale to help nurses perform assessments of risk for pressure ulcers. We also worked with local champions to adapt educational strategies to the local environment, for example, by creating carts customized to each ICU to facilitate adherence to sterile precautions when inserting central venous catheters. Such customized strategies increase the adoption of targeted care practices.3