Variation in the Management of Pain, Agitation, and Delirium in Intensive Care Units in British Columbia.

Background: Pain, agitation, and delirium are associated with negative outcomes in critically ill patients. Reducing variation in pain, agitation, and delirium management among institutions could improve care.

Objectives: To define opportunities to improve pain, agitation, and delirium management in intensive care units in British Columbia, Canada.

Development of a Provincial initiative to improve glucose control in critically ill patients.

Objective: To describe the development, implementation and initial evaluation of an initiative to improve glucose control in critically ill patients.

Design: Glucose control in critically ill patients was chosen by critical care leaders as a target for improvement. This was an observational study to document changes in processes and measures of glucose control in each intensive care unit (ICU).

Using systems thinking to support clinical system transformation.

Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints.

Gamification as a strategy to engage and motivate clinicians to improve care.

Approaching change through seeking commitment rather than requiring compliance is an effective way to promote desired behaviours in healthcare. Gamification was explored as a technique to engage clinicians in the adoption of sepsis identification and management tools. Positive extrinsic (eg, feedback and rewards) and intrinsic (eg, mastery, autonomy, relatedness, and purpose) motivators were integrated into a campaign to save lives, leading to a significant reduction in severe sepsis mortality and improvement in processes of care.

Exploring distributed leadership in the BC Sepsis Network.

Commissioned research was undertaken to explore the role of networks in supporting large-scale change and improvement. Participatory action research and social network analysis were used to study the BC Sepsis Network. Findings of this research include insights into distributed leadership, enablers and barriers within a network approach; the importance of relationships and trust; and the need for meaningful and timely data.

Modification of a high frequency oscillator circuit with a heated expiratory filter to prevent infectious pathogen transmission: a bench study.

Background: High frequency oscillation is a safe and effective treatment for patients with ARDS, but poses a patient and caregiver risk when the circuit is disconnected. We modified the circuit to include a heated expiratory filter, eliminating the need for daily filter changes due to buildup of condensate. The purpose of the study was to determine if substitution of the filter resulted in a clinically important change in delivered tidal volume or amplitude.