NURS 8740 Week 3 Descriptive Analysis Section Example

Who Was Counted: A Descriptive Analysis of the Patients and Ventilator Days in the Mobilization Project, Baseline and Protocol Periods

Student Name

College of Nursing, Walden University

NURS 8740: Doctoral Seminar IV

Instructor Name

Month Day, Year

Who Was Counted: A Descriptive Analysis of the Patients and Ventilator Days in the Mobilization Project, Baseline and Protocol Periods

Purpose of This Section

Before any measure is compared across periods, a reader needs to know who was counted, who was left out and whether the two periods describe similar patients. This section reports the flow of records from the cleaned extract to the analysis, then describes the patients and ventilator days in the baseline period, January 5 to February 1, and the first eight protocol weeks, February 2 to March 28. It contains no comparison of the main measure; that belongs in the results. SQUIRE 2.0 asks improvement writers to portray the patients and setting fully enough that a reader can decide whether a difference between periods, rather than the intervention, might account for a change (Ogrinc et al., 2016). That is the whole job of this section, and it stops short of any judgment about the main measure.

Flow of Records

The cleaned extract contained 352 ventilated patient-days. Six duplicates from bed moves, 51 days under the 24-hour threshold and 19 excluded days left 276 qualifying ventilator days, as documented in the data cleaning memo. Those days belonged to 49 patients: 15 in the baseline period and 34 in the protocol period. Days are assigned to a period by date. Patients are assigned by their first qualifying day, a rule written before the data were examined, so the three patients ventilated across February 1 and 2 appear in the baseline column of Table 1 even though some of their days fall in the protocol period.

The 19 excluded days came from eight patients. Five of them also had qualifying days that remain in the analysis; three were excluded on every day of their stay, all with comfort-care orders from the first morning. Those three are not described below, and a reader should know that the description covers patients who were at least potentially eligible for mobilization.

Patient Characteristics

Table 1 describes the 49 patients. Categories were defined before counting. The admitting reason is the primary reason recorded on the ICU admission note, grouped into four categories: respiratory infection, sepsis from another source, cardiac arrest and other. Severity is the Acute Physiology and Chronic Health Evaluation II score recorded by the unit on admission, and three patients had no score recorded. Sedation depth is the share of 0800 Richmond Agitation-Sedation Scale assessments at minus 2 or lighter during each patient's qualifying days.

Table 1

Characteristics of Patients With at Least One Qualifying Ventilator Day, by Period

Note. APACHE II = Acute Physiology and Chronic Health Evaluation II. Percentages for the admitting reason may not total 100 because of rounding. The APACHE II row has its own denominator because the score was not recorded for one baseline patient and two protocol patients.

What the Table Shows and Does Not Show

The two groups are similar in age, sex, admitting reason, severity and length of ventilation. Protocol patients were slightly older and slightly more severely ill on admission, by amounts that a unit of this size would see from one quarter to the next. A difference this small in a group of 15 and a group of 34 cannot be tested in any useful way, and the section does not attempt it.

One row differs by more than the others. Sedation was lighter in the protocol period: 76% of 0800 assessments were at minus 2 or lighter, compared with 64% in the baseline. That difference matters because the hospital switched to a sedation order set aiming for lighter sedation on February 1, the day before the protocol started. Lighter sedation makes sitting up possible for more patients regardless of any mobilization protocol, so this row will be carried into the interpretation of the main measure. Sedation and mobilization are linked in published bundles for exactly this reason (Devlin et al., 2018). Describing the difference now, before the main result is reported, keeps it from looking like an explanation found afterward.

Ventilator Days

The unit of analysis for the main measure is the qualifying day, not the patient, so Table 2 describes the days.

Table 2

Qualifying Ventilator Days, by Period

Note. Safety screens were not part of practice during the baseline period, so that row has no baseline value. A three-patient assignment means at least one nurse on the day shift carried three patients.

Missing Documentation

Missing values are reported where they occur rather than removed. Four baseline days and ten protocol days have no mobility level; under the operational definition they stay in the denominator and count as not reaching level 3. Three APACHE II scores are missing. No sedation assessment was missing at 0800 on any qualifying day, which reflects a long-standing unit routine. Run charts for the main measure will be read with these gaps in view (Perla et al., 2011), and the share of blank days will be plotted alongside the measure so that a change in recording is not mistaken for a change in mobilization.

None of these gaps was filled from free-text notes, therapy documentation or memory, in keeping with the cleaning rules, and the counts above are therefore the counts a second analyst would obtain from the frozen file.

References

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., . . . Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895