Table 6 Statistical justification for aggregating data to the unit level
|  | Site specific barrier score mean ± SD | Variance components |  |  | F-test P-value | |||||
|---|---|---|---|---|---|---|---|---|---|---|
Questionnaire items | Site 1 | Site 2 | Site 3 | Site 4 | Site 5 | σb 2* | σw 2# | ICC^ | ICC (35)& |  |
N | 37 | 32 | 36 | 29 | 52 | Â | Â | Â | Â | Â |
Overall Barriers | 32.2 ± 26.9 | 31.3 ± 20.9 | 33.3 ± 33.3 | 39.9 ± 35.5 | 26.8 ± 19.0 | 7.67 | 522.66 | 0.01 | 0.34 | 0.2 |
Subscale 1: Guideline Recommendations and Implementation Strategies | 27.5 ± 28.6 | 38.2 ± 25.0 | 22.4 ± 27.9 | 26.4 ± 21.6 | 21.4 ± 21.0 | 0.00 | 602.27 | 0.00 | 0.00 | 0.77 |
Current scientific evidence supporting some nutrition interventions is inadequate to inform practice. | 23.8 ± 31.9 | 28.7 ± 34.2 | 18.6 ± 29.8 | 29.5 ± 30.3 | 22.4 ± 26.7 | 0.00 | 908.80 | 0.00 | 0.00 | 0.6 |
The language of the recommendations of the current guidelines for nutrition are not easy to understand. | 28.7 ± 33.9 | 26.4 ± 34.9 | 18.6 ± 29.8 | 33.3 ± 33.3 | 12.2 ± 27.8 | 46.18 | 998.05 | 0.04 | 0.62 | 0.03 |
The current guidelines for nutrition are not readily accessible when I want to refer to them. | 35.2 ± 35.6 | 31.1 ± 31.5 | 24.5 ± 35.1 | 34.6 ± 35.2 | 33.3 ± 35.5 | 0.00 | 1196.27 | 0.00 | 0.00 | 0.71 |
No feeding protocol in place to guide the initiation and progression of enteral nutrition. | 25.0 ± 33.2 | 25.3 ± 34.1 | 31.4 ± 33.3 | 26.2 ± 29.2 | 19.6 ± 28.4 | 0.00 | 984.31 | 0.00 | 0.00 | 0.56 |
Current feeding protocol is outdated. | 23.8 ± 36.7 | 16.0 ± 29.8 | 19.0 ± 30.6 | 15.4 ± 25.4 | 20.7 ± 26.8 | 0.00 | 891.70 | 0.00 | 0.00 | 0.8 |
Subscale 2: Delivery of Enteral Nutrition to the Patient | 33.0 ± 31.2 | 38.2 ± 25.0 | 39.3 ± 27.0 | 54.6 ± 29.0 | 30.5 ± 22.5 | 62.18 | 714.14 | 0.08 | 0.75 | 0.005 |
Delay in physicians ordering the initiation of EN. | 33.3 ± 39.0 | 41.1 ± 28.6 | 43.5 ± 36.4 | 49.4 ± 39.6 | 30.1 ± 29.0 | 29.36 | 1175.27 | 0.02 | 0.47 | 0.11 |
No feeding tube in place to start feeding. | 31.5 ± 39.0 | 24.4 ± 34.9 | 37.0 ± 33.6 | 59.5 ± 34.4 | 26.3 ± 31.9 | 155.32 | 1197.87 | 0.11 | 0.82 | 0.0006 |
Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e., high gastric residual volumes). | 25.9 ± 37.5 | 35.6 ± 37.1 | 33.3 ± 30.9 | 53.6 ± 36.7 | 24.4 ± 28.1 | 97.41 | 1124.24 | 0.08 | 0.75 | 0.004 |
Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes). | 34.3 ± 37.8 | 48.9 ± 32.4 | 40.7 ± 34.8 | 56.8 ± 33.1 | 32.1 ± 31.6 | 70.09 | 1150.70 | 0.06 | 0.68 | 0.02 |
In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. | 39.8 ± 35.5 | 41.1 ± 33.5 | 41.7 ± 34.2 | 53.6 ± 37.8 | 37.3 ± 35.1 | 0.00 | 1236.48 | 0.00 | 0.00 | 0.39 |
Subscale 3: Critical Care Provider Attitudes and Behavior | 27.9 ± 30.3 | 44.7 ± 29.5 | 20.8 ± 26.2 | 31.8 ± 29.5 | 33.0 ± 24.3 | 51.15 | 764.14 | 0.06 | 0.70 | 0.01 |
Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed enterally. | 34.4 ± 33.3 | 60.0 ± 32.0 | 24.1 ± 33.4 | 30.9 ± 33.2 | 32.7 ± 36.2 | 148.80 | 1154.98 | 0.11 | 0.82 | 0.0006 |
Nurses failing to progress feeds as per the feeding protocol. | 22,2 ± 34.7 | 35.6 ± 38.1 | 14.8 ± 25.8 | 27.4 ± 31.5 | 34.0 ± 35.2 | 44.12 | 1115.92 | 0.04 | 0.58 | 0.05 |
Fear of adverse events due to aggressively feeding patients. | 28.7 ± 33.9 | 28.9 ± 34.7 | 23.1 ± 31.7 | 36.9 ± 36.7 | 24.2 ± 30.6 | 0.00 | 1096.86 | 0.00 | 0.00 | 0.48 |
Feeding being held too far in advance of procedures or operating room visits. | 24.8 ± 34.6 | 54.4 ± 38.6 | 21.3 ± 31.7 | 33.3 ± 36.3 | 41.8 ± 33.2 | 143.22 | 1166.23 | 0.11 | 0.81 | 0.0006 |
Subscale 4: Dietitian Support | 33.3 ± 37.1 | 37.9 ± 28.0 | 28.1 ± 28.3 | 40.4 ± 25.7 | 23.4 ± 21.7 | 35.26 | 710.07 | 0.05 | 0.63 | 0.03 |
Waiting for the dietitian to assess the patient. | 27.6 ± 40.8 | 34.4 ± 33.3 | 27.8 ± 33.3 | 37.0 ± 33.8 | 21.8 ± 28.7 | 7.73 | 1137.44 | 0.01 | 0.19 | 0.32 |
Not enough dietitian time dedicated to the ICU during regular weekday hours. | 21.3 ± 33.0 | 34.4 ± 33.3 | 21.9 ± 33.3 | 35.7 ± 38.4 | 11.5 ± 24.6 | 76.09 | 1014.70 | 0.07 | 0.72 | 0.005 |
No or not enough dietitian coverage during evenings, weekends and holidays. | 30.6 ± 38.5 | 52.2 ± 37.8 | 29.5 ± 35.9 | 51.2 ± 34.5 | 32.1 ± 30.9 | 91.75 | 1241.46 | 0.07 | 0.72 | 0.009 |
There is not enough time dedicated to education and training on how to optimally feed patients. | 27.8 ± 29.3 | 32.2 ± 35.1 | 31.5 ± 31.8 | 36.9 ± 35.5 | 28.1 ± 30.1 | 0.00 | 1011.24 | 0.00 | 0.00 | 0.78 |
Subscale 5: ICU Resources | 42.9 ± 32.8 | 28.7 ± 29.5 | 23.1 ± 30.7 | 43.7 ± 34.3 | 20.5 ± 24.4 | 95.09 | 892.58 | 0.10 | 0.79 | 0.0009 |
Not enough nursing staff to deliver adequate nutrition. | 18.5 ± 29.2 | 17.8 ± 27.3 | 17.6 ± 34.3 | 38.1 ± 42.3 | 10.3 ± 23.4 | 76.36 | 953.62 | 0.07 | 0.74 | 0.006 |
Enteral formula not available on the unit. | 53.7 ± 44.6 | 33.3 ± 37.1 | 32.4 ± 36.1 | 42.9 ± 38.3 | 17.9 ± 28.4 | 149.67 | 1330.97 | 0.10 | 0.80 | 0.0003 |
No or not enough feeding pumps on the unit. | 56.5 ± 42.0 | 37.9 ± 38.5 | 19.4 ± 32.2 | 50.0 ± 38.0 | 33.3 ± 33.7 | 172.74 | 1343.58 | 0.11 | 0.82 | 0.0003 |