IMPROVING INTENSIVE-CARE - OBSERVATIONS BASED ON ORGANIZATIONAL CASE-STUDIES IN 9 INTENSIVE-CARE UNITS - A PROSPECTIVE, MULTICENTER STUDY

被引:189
作者
ZIMMERMAN, JE
SHORTELL, SM
ROUSSEAU, DM
DUFFY, J
GILLIES, RR
KNAUS, WA
DEVERS, K
WAGNER, DP
DRAPER, EA
机构
[1] NORTHWESTERN UNIV,CTR HLTH SERV & POLICY RES,EVANSTON,IL 60201
[2] NORTHWESTERN UNIV,JL KELLOGG GRAD SCH MANAGEMENT,EVANSTON,IL 60201
[3] APACHE MED SYST INC,BALTIMORE,MD
[4] NORTHWESTERN UNIV,DEPT SOCIOL,EVANSTON,IL 60201
[5] GEORGETOWN UNIV,SCH NURSING,WASHINGTON,DC 20057
关键词
INTENSIVE CARE UNITS; HOSPITAL ADMINISTRATION; QUALITY ASSURANCE; HEALTH CARE; ORGANIZATION AND ADMINISTRATION; OUTCOME ASSESSMENT; OUTCOME AND PROCESS ASSESSMENT; HOSPITAL MORTALITY; NURSE ADMINISTRATORS; NURSING STAFF; HOSPITAL; TASK PERFORMANCE AND ANALYSIS;
D O I
10.1097/00003246-199310000-00010
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective. To examine organizational practices associated with higher and lower intensive care unit (ICU) outcome performance. Design: Prospective multicenter study. On-site organizational analysis; prospective inception cohort. Setting. Nine ICUs (one medical, two surgical, six medical-surgical) at five teaching and four nonteaching hospitals. Participants: A sample of 3,672 ICU admissions; 316 nurses and 202 physicians. Materials and Methods. Interviews and direct observations by a team of clinical and organizational researchers. Demographic, physiologic, and outcome data for an average of 408 admissions per ICU; and questionnaires on ICU structure and organization. The ratio of actual/predicted hospital death rate was used to measure ICU effectiveness; the ratio of actual/predicted length of ICU stay was used to assess efficiency. Measurements and Main Results: ICUs with superior risk-adjusted survival could not be distinguished by structural and organizational questionnaires or by global judgment following on-site analysis. Superior organizational practices among these ICUs were related to a patient-centered culture, strong medical and nursing leadership, effective communication and coordination, and open, collaborative approaches to solving problems and managing conflict. Conclusions: The best and worst organizational practices found in this study can be used by ICU leaders as a checklist for improving ICU management.
引用
收藏
页码:1443 / 1451
页数:9
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