{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:48:44Z","timestamp":1778665724007,"version":"3.51.4"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T00:00:00Z","timestamp":1537833600000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the occurrence of adverse events during a multifaceted program implementation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional secondary analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The respiratory-ICU of a large tertiary care center.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A \u2018Wear the Institution's T-shirt\u2019 monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects \u2018Pneumonia Zero\u2019 and \u2018Bacteremia Zero\u2019. Finally, actions of both projects were implemented.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Rates of adverse events (episodes per 1000 patient\/days).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17\u20130.55), pneumothorax (0.48, 0.26\u20130.87), change of endotracheal tube (0.17, 0.07\u20130.44), atelectasis (0.37, 0.20\u20130.68) and death in the ICU (0.82, 0.69\u20130.97).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/intqhc\/mzy198","type":"journal-article","created":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T23:32:56Z","timestamp":1536103976000},"page":"480-484","source":"Crossref","is-referenced-by-count":1,"title":["Impact of strategic planning, organizational culture imprint and care bundles to reduce adverse events in the ICU"],"prefix":"10.1093","volume":"31","author":[{"given":"Pablo","family":"\u00c1lvarez-Maldonado","sequence":"first","affiliation":[{"name":"Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c\/Dr. Balmis 148, Colonia Doctores, Delegaci\u00f3n Cuauht\u00e9moc, CP, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arturo","family":"Reding-Bernal","sequence":"additional","affiliation":[{"name":"Research Division, General Hospital of Mexico, c\/Dr. Balmis 148, Colonia Doctores, Delegaci\u00f3n Cuauht\u00e9moc, CP, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Hern\u00e1ndez-Sol\u00eds","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c\/Dr. Balmis 148, Colonia Doctores, Delegaci\u00f3n Cuauht\u00e9moc, CP, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ra\u00fal","family":"Cicero-Sabido","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c\/Dr. Balmis 148, Colonia Doctores, Delegaci\u00f3n Cuauht\u00e9moc, CP, Mexico City, Mexico"},{"name":"Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Copilco, Cd. Universitaria, CP 04510 Coyoac\u00e1n, Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,9,19]]},"reference":[{"key":"2019102209292640400_mzy198C1","doi-asserted-by":"crossref","first-page":"i2139","DOI":"10.1136\/bmj.i2139","article-title":"Medical error-the third leading cause of death in the US","volume":"353","author":"Makary","year":"2016","journal-title":"BMJ"},{"key":"2019102209292640400_mzy198C2","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1097\/CCM.0000000000002463","article-title":"Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events","volume":"45","author":"Rawat","year":"2017","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C3","doi-asserted-by":"crossref","first-page":"e806","DOI":"10.1097\/CCM.0000000000002449","article-title":"Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: the Promoting Respect and Ongoing Safety through Patient Engagement Communication and Technology Study","volume":"45","author":"Dykes","year":"2017","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C4","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/intqhc\/mzx009","article-title":"A flowchart for building evidence-based care bundles in intensive care: based on a systematic review","volume":"29","author":"Borgert","year":"2017","journal-title":"Int J Qual Health Care"},{"key":"2019102209292640400_mzy198C5","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/intqhc\/mzx040","article-title":"Reducing the incidence of pressure ulcers in critical care units: a 4-year quality improvement","volume":"29","author":"Richardson","year":"2017","journal-title":"Int J Qual Health Care"},{"key":"2019102209292640400_mzy198C6","doi-asserted-by":"crossref","first-page":"e877","DOI":"10.1097\/CCM.0000000000002533","article-title":"Clinical Practice Guideline: safe medication use in the ICU","volume":"45","author":"Kane-Gill","year":"2017","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C7","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jcrc.2007.09.002","article-title":"Improving patient safety in intensive care units in Michigan","volume":"23","author":"Pronovost","year":"2008","journal-title":"J Crit Care"},{"key":"2019102209292640400_mzy198C8","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/CCM.0000000000002736","article-title":"Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU \u2018Pneumonia Zero\u2019 program","volume":"46","author":"\u00c1lvarez-Lerma","year":"2018","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C9","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1097\/CCM.0b013e3182923622","article-title":"Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience","volume":"41","author":"Palomar","year":"2013","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C10","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1097\/01.CCM.0000171609.91035.BD","article-title":"The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care","volume":"33","author":"Rothschild","year":"2005","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C11","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1007\/s00134-009-1461-0","article-title":"Reduction of ventilator-associated pneumonia: active versus passive guideline implementation","volume":"35","author":"Hawe","year":"2009","journal-title":"Intensive Care Med"},{"key":"2019102209292640400_mzy198C12","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1097\/CCM.0000000000002556","article-title":"Preventing harm in the ICU-Building a culture of safety and engaging patients and families","volume":"45","author":"Thornton","year":"2017","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C13","doi-asserted-by":"crossref","first-page":"e1165","DOI":"10.1097\/CCM.0000000000002691","article-title":"Interventions to improve hand hygiene compliance in the ICU: a systematic review","volume":"45","author":"Lydon","year":"2017","journal-title":"Crit Care Med"},{"key":"2019102209292640400_mzy198C14","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.medin.2017.03.004","article-title":"Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients","volume":"41","author":"Hern\u00e1ndez-Tejedor","year":"2017","journal-title":"Med Intensiva"},{"key":"2019102209292640400_mzy198C15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcrc.2017.09.180","article-title":"ICU team composition and its association with ABCDE implementation in a quality collaborative","volume":"44","author":"Costa","year":"2017","journal-title":"J Crit Care"},{"key":"2019102209292640400_mzy198C16","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/intqhc\/mzx032","article-title":"Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients","volume":"29","author":"Hoffman","year":"2017","journal-title":"Int J Qual Health Care"},{"key":"2019102209292640400_mzy198C17","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1136\/bmjqs-2017-006574","article-title":"How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study","volume":"27","author":"Bradley","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"2019102209292640400_mzy198C18","doi-asserted-by":"crossref","first-page":"e017708","DOI":"10.1136\/bmjopen-2017-017708","article-title":"Association between organisational and workplace cultures, and patient outcomes: systematic review","volume":"7","author":"Braithwaite","year":"2017","journal-title":"BMJ Open"},{"key":"2019102209292640400_mzy198C19","first-page":"CD008315","article-title":"The effectiveness of strategies to change organisational culture to improve healthcare performance","volume":"1","author":"Parmelli","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2019102209292640400_mzy198C20","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1093\/intqhc\/mzu027","article-title":"DUQuE Project Consortium. The associations between organizational culture, organizational structure and quality management in European hospitals","volume":"26","author":"Wagner","year":"2014","journal-title":"Int J Qual Health Care"},{"key":"2019102209292640400_mzy198C21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/intqhc\/mzu091","article-title":"Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use","volume":"27","author":"Ukawa","year":"2015","journal-title":"Int J Qual Health Care"},{"key":"2019102209292640400_mzy198C22","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1136\/bmjqs-2017-006989","article-title":"Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: a mixed-methods intervention study","volume":"27","author":"Curry","year":"2018","journal-title":"BMJ Qual Saf"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/intqhc\/article-pdf\/31\/6\/480\/30259351\/mzy198.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/intqhc\/article-pdf\/31\/6\/480\/30259351\/mzy198.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T11:15:55Z","timestamp":1571742955000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/31\/6\/480\/5102206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,19]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,9,19]]},"published-print":{"date-parts":[[2019,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzy198","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"value":"1353-4505","type":"print"},{"value":"1464-3677","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,7]]},"published":{"date-parts":[[2018,9,19]]}}}