Critical care clinics
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Delirium in the intensive care unit (ICU) is exceedingly common, and risk factors for delirium among the critically ill are nearly ubiquitous. Addressing modifiable risk factors including sedation management, deliriogenic medications, immobility, and sleep disruption can help to prevent and reduce the duration of this deadly syndrome. The ABCDE approach to critical care is a bundled approach that clinicians can implement for many patients treated in their ICUs to prevent the adverse outcomes associated with delirium and critical illness.
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Critical care clinics · Jan 2013
ReviewVentilator-associated complications, including infection-related complications: the way forward.
Acute respiratory failure represents the most common condition requiring admission to an adult intensive care unit. Ventilator-associated pneumonia (VAP) has been used as a marker of quality for patients with respiratory failure. ⋯ The use of ventilator-associated complications (VACs) has been proposed as an objective marker to assess the quality of care for this patient population. The use of evidence-based bundles targeting the reduction of VACs, as well as the conduct of prospective studies showing that VACs are preventable complications, are reasonable first-steps in addressing this important clinical problem.
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Critical care clinics · Jan 2013
ReviewEnhancing the quality of care in the intensive care unit: a systems engineering approach.
This article presents an overview of systems engineering and describes common core principles found in systems engineering methodologies. The Patient Care Program Acute Care Initiative collaboration between the Armstrong Institute of the Johns Hopkins School of Medicine and the Gordon and Betty Moore Foundation, which will use systems engineering to reduce patient harm in the intensive care unit, is introduced. Specific examples of applying a systems engineering approach to the Patient Care Program Acute Care Initiative are presented.
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Critical care clinics · Jan 2013
ReviewImproving intensive care unit quality using collaborative networks.
Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario. More research is needed to understand the mechanisms through which collaborative networks lead to improved care delivery and to demonstrate their cost-effectiveness in comparison with other approaches to system-level quality improvement.