New ways to reduce unnecessary variation and improve outcomes in the intensive care unit

Abstract

The care of critically ill patients and the advent of the modern day intensive care unit (ICU) present a large person power and cost burden to society. The high cost of critical care is attributed to high overhead expenses (eg, experienced staff and equipment), high resource utilization (eg, pharmaceutical resources, lab testing, imaging procedures), and high demand for services. Pathways to standardize numerous facets of patient care have been shown to improve the efficiency of delivery of care and to reduce resource utilization, and are becoming the most sought-after means of improving patient outcomes and reducing overall ICU expenditures. A number of large, randomized, prospective trials have demonstrated that protocol-based strategies can not only reduce variation and cost of ICU medicine but also improve morbidity and mortality of critically ill patients requiring ICU support. In this article, we discuss examples of these trials investigating four major areas of modern ICU medicine: ventilator management, ventilator weaning, sedation and analgesia, and blood transfusions.

The care of critically ill children after hematopoietic SCT: a North American survey

“…[17][18][19] Furthermore, it has been reported that protocol-based therapies may enhance and maintain the quality and efficiency of care thereby resulting in decreased morbidity and mortality. 17,18 The high response rate to this survey suggests a general motivation of physicians from both the HSCT and PCCM services to improve the outcomes of the critically ill pediatric HSCT patient. Such motivation will clearly be needed to establish clinical guidelines and protocolized treatment plans.…”

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

“…1,11,30,31,40,43,45 Integrating cost analysis into the assessment of clinical pathways and care processes may reveal expensive steps or activities that do not add value to patient care as well as significant cost differences that could translate into potentially unnecessary process variation. 19,36 Furthermore, linking cost analysis to the implementation of improvement measures and redesign initiatives has become critical to ensure that outcomes are being improved and costs are being simultaneously contained or reduced to optimize the delivery of value-based care. 23,40,41,45 The time-driven ABC (TD-ABC) method, described by Kaplan and colleagues, has been gaining popularity in health economics as a costing methodology with the potential to support value-optimization initiatives.…”

Evidenzbasierte Bedarfsplanung f�r Intensivbetten

“…Quelle: nach Pronovost et al 2001a;Randolph/Pronovost 2002;Holcomb et al 2001;Carlson et al 1996, adaptiert …”

“…B. Entwöhnung von der Beatmung, Umgang mit Sedativen oder der Transfusion (Holcomb et al 2001;Morris 2001;Wall et al 2001;Randolph/Pronovost 2002;Brattebo et al 2002).…”