Intensive Care

In-depth review of the anaesthetics and intensive care medicine workforce (CfWI) [UK] – 26 February 2015

Posted on March 5, 2015. Filed under: Anaesthesiology, Intensive Care, Workforce | Tags: , |

In-depth review of the anaesthetics and intensive care medicine workforce (CfWI) [UK] – 26 February 2015

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AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent – 10 September 2012

Posted on September 11, 2012. Filed under: Infection Control, Intensive Care | Tags: , |

AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent – 10 September 2012

“A unique nationwide patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ) reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units by 40 percent, according to the agency’s preliminary findings of the largest national effort to combat CLABSIs to date. The project used the Comprehensive Unit-based Safety Program (CUSP) to achieve its landmark results that include preventing more than 2,000 CLABSIs, saving more than 500 lives and avoiding more than $34 million in health care costs.”

… continues

Details about AHRQ’s national CUSP project are available at http://www.ahrq.gov/qual/hais.htm. AHRQ’s CUSP toolkit is available at http://www.ahrq.gov/cusptoolkit/ .”

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NQF Endorses Pulmonary and Critical Care Measures – National Quality Forum [US] – 31 July 2012

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Intensive Care, Respiratory Medicine | Tags: , , , , , |

NQF Endorses Pulmonary and Critical Care Measures – National Quality Forum [US] – 31 July 2012

“Washington, DC – the National Quality Forum (NQF) Board of Directors has endorsed 19 measures related to pulmonary conditions and the critical care setting. The measures focus on treatment processes and outcomes for asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.”

“The measures include those that have been endorsed for at least three years and are now undergoing NQF endorsement maintenance. The ongoing evaluation and updating of endorsed measures ensures they are current and relevant to NQF’s pulmonary/critical care portfolio. In all, 35 measures were evaluated against NQF’s endorsement criteria; 19 received endorsement status. Three were new measures and 16 were maintenance measures. Further harmonization efforts are underway for a sub-set of measures. Three measures are still under review.”

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Using Care Bundles to Improve Health Care Quality – Institute for Healthcare Improvement – 2012

Posted on June 1, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Intensive Care | Tags: |

Using Care Bundles to Improve Health Care Quality – Institute for Healthcare Improvement – 2012

IHI Innovation Series white paper by Resar R, Griffin FA, Haraden C, Nolan TW.

“In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes. The theory was that enhancing teamwork and communication in multidisciplinary teams would create the necessary conditions for safe and reliable care in the ICU. We focused on areas with potential for great harm and high cost, and where the evidence base was strong.

While there were many changes the teams in the initiative worked toward implementing, care of patients on ventilators and those who had central lines became a strong focus, as it satisfied all of our criteria: the evidence for the clinical changes was robust, and there was little or no controversy concerning their efficacy. Further, teams would need to find new and better ways to work together to produce reliable change and superior patient outcomes. We found that by using a “bundle” — a small set of evidence-based interventions for a defined patient population and care setting — the improvements in patient outcomes exceeded expectations of both teams and faculty.

Thus began an innovative approach to improving care: the use of bundles. This white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles over the past decade. We reflect on what we have learned and make suggestions for further research and implementation of the bundle approach to improving care.”

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Funding intensive care — approaches in systems using diagnosis-related groups – RAND – May 2010

Posted on May 12, 2010. Filed under: Health Economics, Intensive Care | Tags: , , , |

Funding intensive care — approaches in systems using diagnosis-related groups – RAND – May 2010
 
By: Stefanie Ettelt, Ellen Nolte
Pages: 104
Document Number: TR-792-DH

This report reviews approaches to funding intensive care in health systems that use activity-based payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Mechanisms of funding intensive care services tend to fall into three broad categories: (1) those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy; (2) those that use DRGs in combination with co-payments (Victoria, France); and (3) those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). The review suggests that there is no obvious example of “best practice” or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment.

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Reducing Average Length of Stay on Mechanical Ventilation Using Bundles and Mobility

Posted on April 29, 2009. Filed under: Intensive Care | Tags: |

Reducing Average Length of Stay on Mechanical Ventilation Using Bundles and Mobility
University of Rochester Medical Center
Rochester, New York, USA

The team from University of Rochester Medical Center is a participant in IHI’s Improving Outcomes for High-Risk and Critically Ill Patients Learning and Innovation Community.

Aim

The team’s overarching goal was to achieve a 20 percent reduction in length of stay across all adult intensive care units (ICUs) by:

* Achieving and sustaining a reduction in ventilator-associated pneumonia (VAP) to less than 1 VAP per 1,000 ventilator days before December 2009 by attaining greater than 95 percent compliance with daily sedation interruption and patient mobility

* Reducing complications from central lines by 90 percent before December 2009 by implementing the Central Line Insertion Bundle and a Central Line Maintenance Bundle, and mandating data collection on all ICUs to track compliance

… information continues on the website

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