Identifying and implementing quality improvement measures in the intensive care unit

Current Opinion in Critical Care

Volumn 13, Issue 6, 2007, Pages 709-713

  Kahn, Jeremy M ^a,b   Fuchs, Barry D ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

Critical care; Intensive care unit; Outcome measures; Process measures; Quality of healthcare

Indexed keywords

CLINICAL PRACTICE; HEALTH CARE ORGANIZATION; HEALTH CARE QUALITY; INTENSIVE CARE; INTENSIVE CARE UNIT; OUTCOME ASSESSMENT; PALLIATIVE THERAPY; PATIENT SAFETY; REVIEW; TOTAL QUALITY MANAGEMENT;

CRITICAL CARE; CRITICAL ILLNESS; EFFICIENCY, ORGANIZATIONAL; HUMANS; INTENSIVE CARE UNITS; ORGANIZATIONAL CULTURE; OUTCOME ASSESSMENT (HEALTH CARE); PENNSYLVANIA; PROCESS ASSESSMENT (HEALTH CARE); PROGRAM DEVELOPMENT; QUALITY OF HEALTH CARE; TREATMENT OUTCOME;

EID: 35848964341     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3282f1be5c     Document Type: Review

References (47)

1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
2. Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.
3. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335:1864-1869.
4. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342:1301-1308.
5. Kress JP, Pohlman AS, O'Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477.
6. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344:699-709.
7. Young MP, Gooder VJ, Oltermann MH, et al. The impact of a multidisciplinary approach on caring for ventilator-dependent patients. Int J Qual Healthcare 1998; 10:15-26.
8. Lynn J, Baily MA, Bottrell M, et al. The ethics of using quality improvement methods in healthcare. Ann Intern Med 2007; 146:666-673. An outstanding review of the ethical issues surrounding quality improvement in healthcare.
9. Truog RD, Brock DW, Cook DJ, et al. Rationing in the intensive care unit. Crit Care Med 2006; 34:958-963. A consensus document that updates the definition of rationing in the ICU and provides a framework for debate on the role of rationing in clinical decision making.
10. Lynn J. When does quality improvement count as research? Human subject protection and theories of knowledge. Qual Saf Healthcare 2004; 13:67-70.
11. Casarett D, Karlawish JH, Sugarman J. Determining when quality improvement initiatives should be considered research: proposed criteria and potential implications. JAMA 2000; 283:2275-2280.
12. Bellin E, Dubler NN. The quality improvement-research divide and the need for external oversight. Am J Public Health 2001; 91:1512-1517.
13. Grady C. Quality improvement and ethical oversight. Ann Intern Med 2007; 146:680-681.
14. Donabedian A. The quality of medical care. Science 1978; 200:856-864.
15. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355:2725-2732. A state-wide quality improvement initiative demonstrating that a multifaceted intervention can decrease the incidence of catheter-related bloodstream infections in the ICU.
16. Pronovost PJ, Miller MR, Dorman T, et al. Developing and implementing measures of quality of care in the intensive care unit. Curr Opin Crit Care 2001; 7:297-303.
17. Nelson JE, Mulkerin CM, Adams LL, et al. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Healthcare 2006; 15:264-271. A study describing communication as a target for quality improvement.
18. Jain M, Miller L, Belt D, et al. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Healthcare 2006; 15:235-239. A novel study demonstrating that the ICU climate can be a target for quality improvement.
19. Wall RJ, Engelberg RA, Gries CJ, et al. Spiritual care of families in the intensive care unit. Crit Care Med 2007; 35:1084-1090. Another novel quality improvement area: spiritual care.
20. Curtis JR, Engelberg RA. Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit. Crit Care Med 2006; 34 (Suppl):S341-S347. An excellent review of end-of-life care as a target for quality improvement.
21. Cook DJ, Montori VM, McMullin JP, et al. Improving patients' safety locally: changing clinician behaviour. Lancet 2004; 363:1224-1230.
22. Burroughs TE, Cira JC, Chartock P, et al. Using root cause analysis to address patient satisfaction and other improvement opportunities. Jt Comm J Qual Improve 2000; 26:439-449.
23. Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin 2005; 21:21-30; vii.
24. Olsen S, Neale G, Schwab K, et al. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place. Qual Saf Healthcare 2007; 16:40-44. A study highlighting the importance of using reliable quality improvement measures.
25. Curtis JR, Cook DJ, Wall RJ, et al. Intensive care unit quality improvement: a ''how-to'' guide for the interdisciplinary team. Crit Care Med 2006; 34:211-218. The results of a Society of Critical Care Medicine taskforce on quality improvement.
26. McMillan TR, Hyzy RC. Bringing quality improvement into the intensive care unit. Crit Care Med 2007; 35 (2 Suppl):S59-S65.
27. Garland A. Improving the ICU: part 2. Chest 2005; 127:2165-2179.
28. Garland A. Improving the ICU: part 1. Chest 2005; 127:2151-2164.
29. Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001; 39:II2-II45.
30. Treece PD, Engelberg RA, Shannon SE, et al. Integrating palliative and critical care: description of an intervention. Crit Care Med 2006; 34 (11 Suppl): S380-S387. A groundbreaking multidisciplinary intervention to improve palliative care in the ICU. This paper provides an overview of the intervention and describes how several methods to improve practice can be used to achieve a single goal.
31. Rana R, Afessa B, Keegan MT, et al. Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry. Crit Care Med 2006; 34:1892-1897. A study linking technology with quality improvement.
32. Wall RJ, Ely EW, Elasy TA, et al. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit. Qual Saf Healthcare 2005; 14:295-302.
33. Abella BS, Edelson DP, Kim S, et al. CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation 2007; 73:54-61.
34. Mant J. Process versus outcome indicators in the assessment of quality of healthcare. Int J Qual Healthcare 2001; 13:475-480.
35. Kahn JM, Doctor JN, Rubenfeld GD. Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis. Intens Care Med 2006; 32:1151-1158.
36. Walsh M, Laptook A, Kazzi SN, et al. A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams. Pediatrics 2007; 119:876-890. An important example of how a quality improvement initiative that successfully impacts a process measure can have no effect on the relevant outcome measure.
37. Landon BE, Hicks LS, O'Malley AJ, et al. Improving the management of chronic disease at community health centers. N Engl J Med 2007; 356:921-934. An important example of how a quality improvement initiative that successfully impacts a process measure can have no effect on the relevant outcome measure.
38. Han YY, Carcillo JA, Venkataraman ST, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116:1506-1512.
39. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293:1197-1203.
40. Berwick DM, Calkins DR, McCannon CJ, et al. The 100,000 lives campaign: setting a goal and a deadline for improving healthcare quality. JAMA 2006; 295:324-327.
41. Joint Commission on Accreditation of Healthcare Organizations. Specifications manual for national hospital quality measures - ICU, version 1.0. Oakbrook Terrace, IL:JCAHO; 2005.
42. Brennan TA, Gawande A, Thomas E, et al. Accidental deaths, saved lives, and improved quality. N Engl J Med 2005; 353:1405-1409.
43. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med 2005; 353:1685-1693.
44. Trzeciak S, Dellinger RP, Abate NL, et al. Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department. Chest 2006; 129:225-232.
45. Yilmaz M, Keegan MT, Iscimen R, et al. Toward the prevention of acute lung injury: protocol-guided limitation of large tidal volume ventilation and inappropriate transfusion. Crit Care Med 2007; 35:1660-1666. A recent paper showing how quality improvement initiatives can be based around implementing efficacious treatments.
46. Nguyen HB, Corbett SW, Steele R, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 2007; 35:1105-1112.
47. Wolthuis EK, Korevaar JC, Spronk P, et al. Feedback and education improve physician compliance in use of lung-protective mechanical ventilation. Intens Care Med 2005; 31:540-546.