Organizational characteristics and the quality of surgical care.
OBJECTIVE
Public recognition of wide variations in surgical outcomes has prompted numerous efforts aimed at measuring and improving quality. Given that many of the most prominent efforts focus on organizational factors, this paper reviews the growing body of evidence underlying these initiatives.


RESULTS
Physician, nurse, and pharmacist staffing are strongly related to outcomes for critically ill surgical patients. New technologic innovation, particularly computerized physician order entry, has the potential to markedly reduce medical errors in this population. Creating an infrastructure for the measurement and improvement of surgical quality also shows significant promise for improving outcomes.


CONCLUSIONS
Several organizational characteristics are strongly related outcomes for critically ill surgical patients. Increasing the number of surgical patients receiving care in hospitals adhering to these organizational practices would save many lives each year.
Dimick
Justin B
JB
VA Outcomes Group, VA Medical Center, White River Junction, VT 05009, USA. Justin.B.Dimick@Dartmouth.edu
D003422:Critical Care / Q000458:organization & administration*; D017598:Efficiency, Organizational; D013502:General Surgery / Q000458:organization & administration; D006801:Humans; D050316:Medical Order Entry Systems; D015279:Organizational Culture; D019990:Perioperative Care / Q000458:organization & administration*; D013527:Perioperative Nursing / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D014481:United States