Daily use and dose of benzodiazepine and narcotics, daily sedation and delirium status, and daily functional mobility measures were compared across the pre-QI and QI periods using linear, logistic, and multinomial regression models with robust

variance estimates to account for the correlation of repeated daily measures from the same person during their MICU stay.28 For linear regression analyses of midazolam- and morphine-equivalent drug doses, data were log-transformed. T tests were used to evaluate the difference in average ICU and hospital LOS comparing the pre-QI and QI periods. All analyses were performed using Stata 10.0 software. a A 2-sided P value less than .05 was used to determine statistical significance. A detailed description

of the proposed project was provided to the institutional review board Chair. On review of the project, it was considered to be “quality improvement” in nature and thus did not require institutional Ibrutinib chemical structure review board approval. This QI project was reported in accordance with the Standards for Quality Improvement Reporting Excellence guidelines.29 All eligible MICU patients during the pre-QI and QI periods were included in the project, representing a total of 27 and 30 patients requiring 312 and 482 MICU patient days, respectively. These patients represented approximately 10% of all ERK inhibitor MICU admissions during each of the 2 time periods. Compared with the immediately prior pre-QI period, patients in the QI period tended to be slightly older with greater comorbidities at baseline and greater PDK4 severity of illness in the MICU (table 1). With respect to the first objective of the QI project, in comparison with the pre-QI period, we found that a lower proportion of MICU patients received benzodiazepines (96% vs 73%, P=.03) and narcotics (96% vs 77%, P=.05). There was a large decrease in the proportion of MICU days in which patients received benzodiazepines (50% vs 26%, P=.002),

but not narcotics (62% vs 66%, P=.65) with lower median doses given (47 vs 15mg of midazolam equivalents [P=.09], 71 vs 24mg of morphine equivalents [P=.01]) ( table 2). Moreover, we found that patients were more frequently alert (29% vs 66% of MICU days, P<.001) and not delirious (21% vs 53%, P=.003). Patients in both periods similarly had very low pain scores, based on routine nursing assessments using a 0 to 10 scale (0.6 vs 0.6, P=.79). With respect to the second objective of this project, during the QI period, important barriers to rehabilitation therapy were surmounted. There was a substantial increase in the proportion of patients who received PT and/or OT therapy in the MICU (70% vs 93%, P=.04) and PM&R-related consultations ( table 3). These improvements led to a substantial decrease in the proportion of MICU days in which eligible patients failed to receive any therapy from a PT and/or OT (41% vs 7%, P=.004).