[Statistical process control as a monitoring tool for the evaluation of reorganisation measures. Investigation in an intensive care unit].
BACKGROUND
The German health care system is currently in a constant state of flux owing to enhanced competition and to the increasing focus on economic aspects. Medical services, especially treatment processes, are being reorganised in an attempt to adapt them to the new economic challenges. Ideally, radical reorganisation and streamlining of medical therapy processes should be accompanied by controlling and quality management systems. The purpose of this is to monitor the intensity of any economic and any patient-related (side)-effects. Business management techniques are needed that allow online and long-term performance reviews of reorganisation measures once initiated.


METHODS
In industry, the method applied for this purpose is statistical process control (SPC). The present study demonstrates for the first time that use of this monitoring tool can be extended to the medical sector. In an intensive care unit (ICU) the following process parameters were monitored: duration of sedation, time to persisting spontaneous breathing, length of stay in ICU, length of stay in hospital, patient mortality in ICU and in the next 30 days after admission to the ICU. Group 1 was made up of 87 patients examined before and group 2, 93 patients after process optimisation. The main feature of the reorganisation was application of a new analgo-sedation technique and of the weaning concept.


RESULTS
In group 2 duration of sedation, time to spontaneous breathing and length of stay on the ICU were significantly shorter than in group 1. The length of stay in hospital, patient mortality in the ICU and 30 days after the initiation of intensive care did not differ significantly between the two groups.


CONCLUSIONS
Economic and patient-related key figures can be evaluated with SPC. It allows online assessment both before and during process optimisation, and especially in the long term afterprocess optimisation.
Poelaert
J
J
Postoperative Cardiac Surgical ICU - K12 - 5 IE, Ghent University Hospital, De Pintelaan 185, B9000 Gent, Belgien. jan.poelaert@ugent.be
Schuepfer
G
G
Umnus
A
A
Bauer
M
M
Schleppers
A
A
D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D016292:Procedural Sedation; D003422:Critical Care / Q000706:statistics & numerical data; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D007902:Length of Stay; D009862:Online Systems; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D015300:Ventilator Weaning
D000700:Analgesics; D006993:Hypnotics and Sedatives