Adherence to guidelines for the management of donors after brain death

Pieter Hoste; Patrick Ferdinande; Dirk Vogelaers; Kris Vanhaecht; Eric Hoste; Xavier Rogiers; Kristof Eeckloo; Koenraad Vandewoude

doi:10.1016/j.jcrc.2018.10.016

Adherence to guidelines for the management of donors after brain death

J Crit Care. 2019 Feb:49:56-63. doi: 10.1016/j.jcrc.2018.10.016. Epub 2018 Oct 22.

Authors

Pieter Hoste¹, Patrick Ferdinande², Dirk Vogelaers³, Kris Vanhaecht⁴, Eric Hoste⁵, Xavier Rogiers⁶, Kristof Eeckloo⁷, Koenraad Vandewoude⁸

Affiliations

¹ Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Intensive Care, General Hospital Sint-Lucas Ghent, Groenebriel 1, 9000 Ghent, Belgium. Electronic address: piehoste.hoste@ugent.be.
² Surgical and Transplantation ICU, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: patrick.ferdinande@uzleuven.be.
³ Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: dirk.vogelaers@ugent.be.
⁴ Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; European Pathway Association, Kapucijnenvoer 35, 3000 Leuven, Belgium. Electronic address: kris.vanhaecht@med.kuleuven.be.
⁵ Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Research Foundation - Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium. Electronic address: eric.hoste@ugent.be.
⁶ Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Transplant Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: xavier.rogiers@ugent.be.
⁷ Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium. Electronic address: kristof.eeckloo@ugent.be.
⁸ Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: koenraad.vandewoude@ugent.be.

PMID: 30388489
DOI: 10.1016/j.jcrc.2018.10.016

Abstract

Purpose: Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance-performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD.

Materials and methods: This observational, cross-sectional multicenter study was performed in 21 Belgian ICUs. A retrospective review of patient records of adult utilized DBDs between 2013 and 2016 used 67 KIs to describe adherence to guidelines.

Results: A total of 296 patients were included. Thirty-five of 67 KIs had a high level of adherence congruent to a high expert panel rating of importance. Nineteen of 67 KIs had a low level of adherence in spite of a high level of importance according to expert consensus. However, inadequate documentation proved an important issue, hampering true guideline adherence assessment. Adherence ranged between 3 and 100% for single KI items and on average, patients received 72% of the integrated expert panel recommended care set.

Conclusions: Guideline adherence to an expert panel predefined care set in DBD donor management proved moderate leaving substantial room for improvement. An importance-performance analysis can be used to improve implementation and documentation of guidelines.

Keywords: Donation after brain death; Guideline adherence; Importance-performance analysis; Level of performance; Organ donation; Quality of care.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Belgium
Brain Death / diagnosis*
Consensus
Cross-Sectional Studies
Documentation / standards
Female
Guideline Adherence / standards*
Humans
Male
Middle Aged
Retrospective Studies
Tissue and Organ Procurement / standards