• Samuel A. Tisherman


As medicine has advanced over the past 50 years, the need for high-quality, cost-effective critical care services has expanded exponentially. In the USA, one recent estimate was that five million patients are admitted to intensive care units (ICUs) every year, leading to 23 million ICU bed days [1]. The cost of managing these patients typically accounts for a large percentage of hospital costs.


Critical care metrics ICU staffing Clinical management guidelines Quality improvement 


  1. 1.
    Halpern NA, Pastores SM, Oropello JM, et al. Critical care medicine in the United States: addressing the intensivist shortage and image of the specialty. Crit Care Med. 2013;41:2754–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Wilcox ME, Chong CAKY, Niven DJ, et al. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med. 2013;41:2253–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Wallace DJ, Angus DC, Barnato AE, et al. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med. 2012;366:2093–101.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kerlin MP, Small DS, Cooney E, et al. A randomized trial of nighttime physician staffing in an intensive care unit. N Engl J Med. 2013;368:2201–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Weled BJ, Adzhigirey LA, Hodgman TM, et al. Critical care delivery: the importance of process of care and ICU structure to improved outcomes. An update from the American College of Critical Care Medicine Task Force on Models of Critical Care. Crit Care Med. 2015;43(7):1520–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Bing-Hua YU. Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg. 2014;208:268–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365:139–46.CrossRefPubMedGoogle Scholar
  8. 8.
    Lilly CM, Zubrow MT, Kempner KM, et al. Critical care telemedicine: evolution and state of the art. Crit Care Med. 2014;42:2429–36.CrossRefPubMedGoogle Scholar
  9. 9.
  10. 10.
    Ward NS, Afessa B, Kleinpell R, et al. Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing. Crit Care Med. 2013;41:638–45.CrossRefPubMedGoogle Scholar
  11. 11.
    Donabedian A. Continuity and change in the quest for quality. Clin Perform Qual Health Care. 1993;1:9–16.PubMedGoogle Scholar
  12. 12.
    Curtis JR, Cook DJ, Wall RJ, et al. Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med. 2006;34:211–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Byrnes MC, Schuerer DJ, Schallom ME, et al. Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med. 2009;37:2775–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Gurses AP, Murphy DJ, Martinez EA, et al. A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines. Jt Comm J Qual Patient Saf. 2009;35:526–32. 485.CrossRefPubMedGoogle Scholar
  15. 15.
    Penkoske PA, Buchman TG. The relationship between the surgeon and the intensivist in the surgical intensive care unit. Surg Clin N Am. 2006;86:1351–7.CrossRefPubMedGoogle Scholar
  16. 16.
    St Andre A. The formation, elements of success, and challenges in managing a critical care program (Part I). Crit Care Med. 2015;43(4):874–9.CrossRefPubMedGoogle Scholar
  17. 17.
    St Andre A. The formation, elements of success, and challenges in managing a critical care program (Part II). Crit Care Med. 2015;43(5):1096–101.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

<SimplePara><Emphasis Type="Bold">Open Access</Emphasis> This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. </SimplePara> <SimplePara>The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.</SimplePara>

Authors and Affiliations

  1. 1.Surgical Intensive Care Unit, RA Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimoreUSA

Personalised recommendations