Bringing quality improvement into the intensive care unit.
BACKGROUND
During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care.


OBJECTIVE
To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives.


RESULTS
Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region.


CONCLUSIONS
The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.
McMillan
Tracy R
TR
Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Hyzy
Robert C
RC
D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care / Q000458:organization & administration* / Q000592:standards; D006751:Hospital Information Systems / Q000458:organization & administration; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007902:Length of Stay; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States