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Table 6 Statistical justification for aggregating data to the unit level

From: Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients

  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      
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Current feeding protocol is outdated. 23.8 ± 36.7 16.0 ± 29.8 19.0 ± 30.6 15.4 ± 25.4 20.7 ± 26.8 0.00 891.70 0.00 0.00 0.8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
  1. Variance components calculated using mixed linear regression model with Restricted Maximum Likelihood estimation (REML): *= (i.e., ICU), σb 2 = between group (i.e., ICU) variance # σw 2 = within group (i.e., ICU) variance ^ICC = Intraclass correlation coefficient (1,1) = σb 2 / (σb 2 + σw 2) &ICC(1,35) = σb 2/( σb 2 + σw 2/k) where k = 35 respondents per group.
  2. Bolded text = overall and subscale results.