title: Critical care: the impact of organization and management on outcomes.
abstract: OBJECTIVE
  The organization and management of ICUs are key components that can affect delivery and outcome of critical care.
  
  
  RESULTS
  At the healthcare system level, the provision of critical care services and the presence of a regionalized system of critical care delivery may improve optimal matching of patient severity with level of care and is associated with improved patient outcomes. In hospitals, rapid response teams and step-down beds affect admission and discharge criteria to and from the ICU, although the influence on outcome is unclear. And within the ICU, the presence of intensivists, physically or via telemedicine, and multidisciplinary teams may promote better use of therapeutic and preventive measures with improved patient outcomes. Recent findings also emphasize that strategies that promote teamwork and communication, standardize processes of care, emphasize engagement in quality improvement, and provide a positive safety culture are associated with improved patient outcomes and staff morale.
  
  
  CONCLUSIONS
  Evidence suggests the implementation of some ICU organizational and managerial patterns are associated with improved patient and staff outcomes. Broader adoption of some of these strategies could, therefore, improve overall critical care delivery.
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint Antoine, Assistance Publique des Hôpitaux de Paris, Université Paris VI, Paris, France. yenlanfr@aol.com
authors.forename: Yên-Lan
authors.initials: YL
authors.lastname: Nguyen
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D003142:Communication; D003422:Critical Care / Q000458:organization & administration*; D057209:Hospital Rapid Response Team; D015279:Organizational Culture; D016896:Treatment Outcome