• Nathalie McIntosh, Eva Oppel, David Mohr, and Mark Meterko.
• Nathalie McIntosh is a health services researcher and David Mohr is a research health scientist, Center for Healthcare, Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts. Eva Oppel is a postdoctoral fellow, Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany. Mark Meterko is a survey methodologist, VHA Office of Analytics and Business Intelligence, Bedford, Massachusetts, and a research associate professor, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts. nathalie.mcintosh@va.gov.
• Am. J. Crit. Care. 2017 Sep 1; 26 (5): 401-407.

BackgroundImproving patient care quality in intensive care units is increasingly important as intensive care unit services account for a growing proportion of hospital services. Organizational factors associated with quality of patient care in such units have been identified; however, most were examined in isolation, making it difficult to assess the relative importance of each. Furthermore, though most intensive care units now use a closed model, little research has been done in this specific context.ObjectivesTo examine the relative importance of organizational factors associated with patient care quality in closed intensive care units.MethodIn a national exploratory, cross-sectional study focused on intensive care units at US Veterans Health Administration acute care hospitals, unit directors were surveyed about nurse and physician staffing, work resources and training, patient care coordination, rounding, and perceptions of patient care quality. Administrative records yielded data on patient volume and facility teaching status. Descriptive statistics, bivariate analyses, and regression modeling were used for data analysis.ResultsSixty-nine completed surveys from directors of closed intensive care units were returned. Regression model results showed that better patient care coordination (β = 0.43; P = .01) and having adequate work resources (β = 0.26; P = .02) were significantly associated with higher levels of patient care quality in such units (R2 = 0.22).ConclusionsAugmenting work resources and/or focusing limited hospital resources on improving patient care coordination may be the most productive ways to improve patient care quality in closed intensive care units.©2017 American Association of Critical-Care Nurses.

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