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Methodology for the analysis and comparison of protocols for glycaemic control in intensive care.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Fernández-Méndez, Rocío  ORCID logo  https://orcid.org/0000-0002-4989-0687
Rodríguez-Villar, Sancho 
Méndez, Pablo F 
Windle, Richard 
Adams, Gary George 

Abstract

RATIONALE, AIMS, AND OBJECTIVES: The practice of glycaemic control of critically ill patients admitted to intensive care units (ICUs) is guided by clinical management protocols, designed locally by the ICUs. These protocols differ significantly in their aims and methods. The aim of this study was to develop a standardized methodology for the systematic and objective analysis and comparison of protocols for glycaemic control implemented in any ICU. METHOD: The protocols for glycaemic control implemented in seven ICUs of a UK-based ICU network were analysed using techniques of inductive content analysis, through an open coding process and the framework method. This involved the identification and classification of protocol instructions for glycaemic control, as well as of the processes and decisions pertaining to each of these instructions. These were used to develop a framework for the structured and systematic description and comparison of the protocols' contents, and to develop a technique for the protocols' graphic visualization. RESULTS: The following elements were identified or developed: (1) 35 quantifiable variables and 11 non-quantifiable subjects that could be present in an ICU protocol for glycaemic control, to be used as a framework for the description and comparison of contents; (2) a technique for condensing a protocol into a single, comprehensive flowchart; (3) using these flowcharts, a method for assessing the complexity and comprehensiveness of the protocols. CONCLUSIONS: The methodology developed in this study will allow for any future work analysing the contents of glycaemic control protocols to be carried out in a structured and standardized way. This may be done either as a standalone study, or as the essential first step in any investigation on the impact of new protocols. In turn, the methodology will facilitate the performance of regional, national, and international comparisons, demonstrating the usefulness of this study at a global scale.

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Keywords

analytical framework, blood glucose, clinical protocols, critical care, evaluation methodology, guidelines, Blood Glucose, Clinical Protocols, Critical Illness, Glycemic Index, Humans, Hyperglycemia, Intensive Care Units, Medical Audit, United Kingdom

Journal Title

J Eval Clin Pract

Conference Name

Journal ISSN

1356-1294
1365-2753

Volume Title

25

Publisher

Wiley