title: Expanding a performance improvement initiative in critical care from hospital to system.
abstract: BACKGROUND
  Concern about the expense and effects of intensive care prompted the development and implementation of a hospital-based performance improvement initiative in critical care at North Shore University Hospital, Manhasset, New York, a 730-bed acute care teaching hospital. THE HOSPITAL-BASED PERFORMANCE IMPROVEMENT INITIATIVE IN CRITICAL CARE: The initiative was intended to use a uniform set of measurements and guidelines to improve patient care and resource utilization in the intensive care units (ICUs), to establish and implement best practices (regarding admission and discharge criteria, nursing competency, unplanned extubations, and end-of-life care), and to improve performance in the other hospitals in the North Shore-Long Island Jewish Health System. In the medical ICU, the percentage of low-risk (low-acuity) patients was reduced from 42% to 22%. ICU length of stay was reduced from 4.6 days to 4.1 days.
  A system-level critical care committee was convened in 1996 and charged with replicating the initiative. By and large, system efforts to integrate and implement policies have been successful. The critical care initiative has provided important comparative data and information from which to gauge individual hospital performance.
  
  
  CONCLUSIONS
  Changing the critical care delivered on multiple units at multiple hospitals required sensitivity to existing organizational cultures and leadership styles. Merging organizational cultures is most successful when senior leadership set clear expectations that support the need for change. The process of collecting, trending, and communicating quality data has been instrumental in improving care practices and fostering a culture of safety throughout the health care system.
authors.affiliation: North Shore-Long Island Jewish Health System, 150 Community Drive, Great Neck, NY 11021, USA.
authors.forename: Yosef D
authors.initials: YD
authors.lastname: Dlugacz
authors.forename: Lori
authors.initials: L
authors.lastname: Stier
authors.forename: Dana
authors.initials: D
authors.lastname: Lustbader
authors.forename: Mitchel C
authors.initials: MC
authors.lastname: Jacobs
authors.forename: Erfan
authors.initials: E
authors.lastname: Hussain
authors.forename: Alice
authors.initials: A
authors.lastname: Greenwood
mesh_terms: D018806:APACHE; D000328:Adult; D019985:Benchmarking; D003142:Communication; D003422:Critical Care / Q000145:classification / Q000592:standards*; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data*; D007857:Leadership; D009096:Multi-Institutional Systems / Q000458:organization & administration / Q000592:standards; D009518:New York; D015279:Organizational Culture; D018570:Risk Assessment; D012720:Severity of Illness Index; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*; D014218:Triage; D014600:Utilization Review