How can clinicians measure safety and quality in acute care?

被引:133
作者
Pronovost, PJ
Nolan, T
Zeger, S
Miller, M
Rubin, H
机构
[1] Johns Hopkins Univ, Sch Med, Dept Anesthesiol Crit Care Med, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Sch Med, Dept Biostat, Baltimore, MD USA
[4] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
[6] Johns Hopkins Univ, Sch Med, Dept Hlth Policy & Management, Baltimore, MD USA
[7] Johns Hopkins Univ, Sch Med, Inst Healthcare Improvement, Baltimore, MD USA
[8] Bloomberg Sch Publ Hlth, Baltimore, MD USA
关键词
D O I
10.1016/S0140-6736(04)15843-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The demand for high quality care is increasing and warranted. Evidence suggests that the quality of care in hospitals can be improved. The greatest opportunity to improve outcomes for patients over the next quarter century will probably come not from discovering new treatments but from learning how to deliver existing effective therapies. To improve, caregivers need to know what to do, how they are doing, and be able to improve the processes of care. The ability to monitor performance, though challenging in healthcare, is essential to improving quality of care. We present a practical method to assess and learn from routine practice. Methods to evaluate performance from industrial engineering can be broadly applied to efforts to improve the quality of healthcare. One method that may help to provide caregivers frequent feedback is time series data-le, results are graphically correlated with time. Broad use of these tools might lead to the necessary improvements in quality of care.
引用
收藏
页码:1061 / 1067
页数:7
相关论文
共 60 条
[1]  
*AAAS, 2003, AAAS AN R D FY 2004
[2]   Short-term and long-term outcome prediction with the Acute Physiology and Chronic Health Evaluation II system after orthotopic liver transplantation [J].
Angus, DC ;
Clermont, G ;
Kramer, DJ ;
Linde-Zwirble, WT ;
Pinsky, MR .
CRITICAL CARE MEDICINE, 2000, 28 (01) :150-156
[3]  
[Anonymous], EFFECT CLIN PRACT
[4]   Efficacy and safety of recombinant human activated protein C for severe sepsis. [J].
Bernard, GR ;
Vincent, JL ;
Laterre, P ;
LaRosa, SP ;
Dhainaut, JF ;
Lopez-Rodriguez, A ;
Steingrub, JS ;
Garber, GE ;
Helterbrand, JD ;
Ely, EW ;
Fisher, CJ .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (10) :699-709
[5]   A primer on leading the improvement of systems [J].
Berwick, DM .
BRITISH MEDICAL JOURNAL, 1996, 312 (7031) :619-622
[6]   Challenges in the care of the acutely ill [J].
Bion, JF ;
Heffner, JE .
LANCET, 2004, 363 (9413) :970-977
[7]   Quality of health care .6. The role of physicians in the future of quality management [J].
Blumenthal, D ;
Epstein, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (17) :1328-1331
[8]  
BRENNAN TA, 1996, NEW RULES REGULATION
[9]   Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. [J].
Brower, RG ;
Matthay, MA ;
Morris, A ;
Schoenfeld, D ;
Thompson, BT ;
Wheeler, A ;
Wiedemann, HP ;
Arroliga, AC ;
Fisher, CJ ;
Komara, JJ ;
Perez-Trepichio, P ;
Parsons, PE ;
Wolkin, R ;
Welsh, C ;
Fulkerson, WJ ;
MacIntyre, N ;
Mallatratt, L ;
Sebastian, M ;
McConnell, R ;
Wilcox, C ;
Govert, J ;
Thompson, D ;
Clemmer, T ;
Davis, R ;
Orme, J ;
Weaver, L ;
Grissom, C ;
Eskelson, M ;
Young, M ;
Gooder, V ;
McBride, K ;
Lawton, C ;
d'Hulst, J ;
Peerless, JR ;
Smith, C ;
Brownlee, J ;
Pluss, W ;
Kallet, R ;
Luce, JM ;
Gottlieb, J ;
Elmer, M ;
Girod, A ;
Park, P ;
Daniel, B ;
Gropper, M ;
Abraham, E ;
Piedalue, F ;
Glodowski, J ;
Lockrem, J ;
McIntyre, R .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (18) :1301-1308
[10]   Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care - A pilot study in a tertiary-care hospital [J].
Buist, MD ;
Jarmolowski, E ;
Burton, PR ;
Bernard, SA ;
Waxman, BP ;
Anderson, J .
MEDICAL JOURNAL OF AUSTRALIA, 1999, 171 (01) :22-25