Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution’s successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line–associated bloodstream infections, and medication errors.
McCannonCJSchallMWCalkinsDRNazemAG. Saving 100000 lives in US hospitals. BMJ. 2006;332:1328-1330.
2.
ShojaniaKGDuncanBWMcDonaldKMWachterRM. Making Health Care Safer: A Critical Analysis of Patient Safety Practices (Evidence Report/Technology Assessment; Report No. 43). Rockville, MD: Agency for Healthcare Research and Quality; 2001.
3.
ThijsLG. Continuous quality improvement in the ICU: general guidelines. Task Force European Society of Intensive Care Medicine. Intensive Care Med. 1997;23:125-127.
4.
GaieskiDFMikkelsenMEBandRA. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med. 2010;38:1045-1053.
5.
KumarAHaeryCPaladuguB. The duration of hypotension before the initiation of antibiotic treatment is a critical determinant of survival in a murine model of Escherichia coli septic shock: association with serum lactate and inflammatory cytokine levels. J Infect Dis. 2006;193:251-258.
6.
DumyatiGConcannonCvan WijngaardenE. Sustained reduction of central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance. Am J Infect Control. 2014;42:723-730.
7.
BoyceJMNadeauJDumiganD. Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and potential effect on central line-associated bloodstream infection reporting. Infect Control Hosp Epidemiol. 2013;34:1042-1047.
8.
WeeksKRHsuYJYangTSawyerMMarstellerJA. Influence of a multifaceted intervention on central line days in intensive care units: results of a national multisite study. Am J Infect Control. 2014;42(10 suppl):S197-S202.
9.
DonabedianA. Evaluating the quality of medical care. Milbank Q. 1966;44:166-203.
10.
Hewson-ConroyKElliottDBurrellAR. Quality and safety in intensive care—a means to an end is critical. Aust Crit Care. 2010;23:109-129.
11.
CurtisJRCookDJWallRJ. Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med. 2006;34:211-218.
12.
PronovostPBerenholtzSNeedhamD. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008;337:a1714. doi:10.1136/bmj.a1714.
13.
JuranJMGodfreyAB. Juran’s Quality Handbook: The Complete Guide to Performance Excellence. 6th ed.New York, NY: McGraw-Hill; 2010.
14.
GershengomHBKocherRFactorP. Management strategies to effect change in intensive care units: lessons from the world of business. Part I: Targeting quality improvement initiatives. Ann Am Thorac Soc. 2014;11:264-269.
15.
GershengomHBKocherRFactorP. Management strategies to effect change in intensive care units: lessons from the world of business. Part II: Quality improvement strategies. Ann Am Thorac Soc. 2014;11:444-453.
