Skip to main content
  • 879 Accesses

Abstract

The performance of an intensive care unit (ICU) has different aspects. For many years ICU performance was synonymous with standard mortality ratio (SMR). Nowadays, however, other aspects of performance are taken into account, which are concerned with the patients’, families’, nurses’, doctors’ and providers’ points of view. Several studies, on the other hand, have demonstrated the relationship between organisation and performance. Improving ICU performance requires that we shift from a paradigm that concentrates on individual performance to a different paradigm that emphasises the need to assess and improve ICU systems and processes. Various observations illustrate the importance of ICUs. One third to one half of Americans spend time in an ICU during their final year of life, and one fifth die there [1]. Quite apart from the death rates, suffering is common among ICU patients [2]; and substantial dissatisfaction among the relatives and friends of ICU patients indicates that suffering is not limited to the patients. In addition, the economic costs of ICU care are staggering. Certain subsets of iatrogenic complications in ICUs occur in 31% of patients and are severe in 13% of patients. Errors were observed in 1% of all the activities performed each day in patients in an Israeli ICU, with a higher rate among physicians than among nurses [3]. Poor communication, teamwork, and problem solving are common among ICU staff and are perceived as being more prevalent and important by ICU nurses than physicians [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Angus DC, Barnato AE, Linde-Zwirble WT et al (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643

    Article  PubMed  Google Scholar 

  2. The SUPPORT Principal Investigators (1995) A controlled trial to improve care for seriously ill hospitalized patients. JAMA 274:1591–1598

    Article  Google Scholar 

  3. Donchin Y, Gopher D, Olin M et al (1995) A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 23:294–300

    Article  PubMed  CAS  Google Scholar 

  4. Miller PA (2001) Nurse-physician collaboration in an intensive care unit. Am J Crit Care 10:341–350

    PubMed  CAS  Google Scholar 

  5. Rapoport J, Teres D, Steingrub J et al (2000) Patient characteristics and ICU organizational factors that influence frequency of pulmonary artery catheterization. JAMA 283:2559–2567

    Article  PubMed  CAS  Google Scholar 

  6. Azoulay E, Chevret S, Leleu G et al (2000) Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 28:3044–3049

    Article  PubMed  CAS  Google Scholar 

  7. Eggimann P, Pittet D (2001) Infection control in the ICU. Chest 120:2059–2209

    Article  PubMed  CAS  Google Scholar 

  8. Angus DC (1998) Grappling with intensive care unit quality: does the readmission rate tell us anything? Crit Care Med 26:1779–1780

    PubMed  CAS  Google Scholar 

  9. Baker DW, Einstadter D, Thomas CL et al (2002) Mortality trends during a program that publicly reported hospital performance. Med Care 40:879–890

    Article  PubMed  Google Scholar 

  10. Ware JE, Snow KK, Kosinski M et al (1993) SF-36 health survey manual & interpretation guide. Health Institute, New England Medical Center, Boston, Mass

    Google Scholar 

  11. Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human. National Academies Press, Washington, DC

    Google Scholar 

  12. Keene AR, Cullen DJ (1983) Therapeutic Intervention Scoring System: update 1983. Crit Care Med 11:1–3

    Article  PubMed  CAS  Google Scholar 

  13. Strauss J, LoGerfo P, Yaltatzie JA et al (1986) Rationing of intensive care services: an everyday occurrence. JAMA 255:1143–1146

    Article  PubMed  CAS  Google Scholar 

  14. Steel RP, Ovalle NK (1984) A review and meta-analysis of research on the relationship between behavioral intentions and employee turnover. J Appl Psychol 69:673–686

    Article  Google Scholar 

  15. Rapin M, Gomez Duque A, Le Gall JR et al (1976) Les chances de survie des malades hospitalisés dans un service de réanimation. Nouv Presse Med 6:1245–1248

    Google Scholar 

  16. Knaus WA, Le Gall JR, Wagner DP et al (1982) A comparison of intensive care in the USA and France. Lancet II:642–646

    Article  Google Scholar 

  17. Le Gall JR, Loirat P (1995) Can we evaluate the performance of an Intensive Care Unit? Curr Opin Crit Care 1:219–220

    Article  Google Scholar 

  18. Ridley S (1998) Severity of illness scoring systems and performance appraisal. Anaesthesia 12:1185–1194

    Article  Google Scholar 

  19. Lemeshow S, Le Gall JR (1994) Modeling the severity of illness of ICU patients. A system update. JAMA 272:1049–1055

    Article  PubMed  CAS  Google Scholar 

  20. Knaus WA, Drape EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:819–829

    Article  Google Scholar 

  21. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiologic Score (SAPS II) based on an European/North American multicenter study. JAMA 270:2957–2963. Correction: JAMA 271:1321

    Article  PubMed  Google Scholar 

  22. Lemeshow S, Teres D, Klar J et al (1993) Mortality Probability Models (MPH II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486

    Article  PubMed  CAS  Google Scholar 

  23. Glance LG, Osler TM, Dick A (2002) Rating the quality of Intensive Care Units: is it a function of the ICU scoring system? Crit Care Med 30:1976

    Article  PubMed  Google Scholar 

  24. Le Gall JR, Lemeshow S, Leleu G et al (1995) Customized probability models for early severe sepsis in adult intensive care patients. JAMA 273:644–650

    Article  PubMed  Google Scholar 

  25. Moreno R, Apolone G (1997) Impact of different customization strategies in the performance of a general severity score. Crit Care Med 25:2001–2008

    Article  PubMed  CAS  Google Scholar 

  26. Metnitz P, Lang T, Vesely H et al (2000) Ratios of observed to expected mortality are affected by difference in case mix and quality of care. Intensive Care Med 26:1466–1472

    Article  PubMed  CAS  Google Scholar 

  27. Knaus WA, Harrel FE, Fischer CJ H Jr et al (1993) The clinical evaluation of new drugs for sepsis: a prospective study design based on survival analysis. JAMA 270:1233–1240

    Article  PubMed  CAS  Google Scholar 

  28. Le Gall JR., Neumann A, Hemery F et al (2005) Expanding the SAPS II improves mortality prediction. Reanimation 14[Suppl 1]

    Google Scholar 

  29. Larche J, Azoulay E, Fieux F et al (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1697

    Article  PubMed  Google Scholar 

  30. Le Gall JR, Klar J, Lemeshow S et al (1996) The logistic Organ Dysfunction System: a new way to assess organ dysfunction in the Intensive Care Unit. JAMA 276:802–810

    Article  PubMed  Google Scholar 

  31. Timsit JF, Fosse JP, Troche G et al (2001) Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized more than 72 h. Intensive Care Med 6:1012–1021

    Google Scholar 

  32. Metnitz PG, Moreno RP, Almeida E et al (2005) SAPS III: from evaluation of the patient to the evaluation of ICU, part 1. Intensive Care Med 10:1336–1344

    Article  Google Scholar 

  33. Moreno RP, Metnitz PG, Almeida E et al (2005) SAPS III: from evaluation of the patient to the evaluation of ICU, part 2. Intensive Care Med 10:1345–1355

    Article  Google Scholar 

  34. Zimmerman JF, Kramer AA, McNair DS et al (2006) Acute physiologies and chronic health evaluation (APACHE IV): hospital mortality assessment for today’s critically ill patients. Crit Care Med 85:1538–1539

    Google Scholar 

  35. Garland A (2005) Improving the ICU. Chest 127:2151–2164

    Article  PubMed  Google Scholar 

  36. Boffelli S, Rossi C, Anguileri A et al (2006) Continuous quality improvement in intensive care Medicine. The GIVITI Margherita project. Report 2005. Minerva Anestesiol 72:419

    PubMed  CAS  Google Scholar 

  37. Herridge M, Cheung AM, Tansey CM et al (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:8

    Article  Google Scholar 

  38. Azoulay E, Pochard F, Chevret S et al (2004) Half the family members of intensive care unit patients do not want to share in the decision making process: A study in 78 French intensive care units. Crit Care Med 32:1832–1838

    Article  PubMed  Google Scholar 

  39. Embriaco N, Barrau K, Azoulay E et al (2005) Prévalence et facteurs de risque du burn out chez les réanimateurs français. Reanimation 14[Suppl 1]:SOE 27

    Google Scholar 

  40. Shortell SR, Zimmerman JE, Gillies RR et al (1994) The performance of intensive care unit: does good management make a difference? Med Care 32:508–525

    Article  PubMed  CAS  Google Scholar 

  41. Azoulay E, Pochard F, Chevret S et al (2001) Meeting the needs of intensive care unit patients’ families—a multicenter study. Am J Respir Crit Care Med 163:135–139

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag Italia

About this paper

Cite this paper

Le Gall, J.R. (2007). Evaluation of performance of ICUs. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0571-6_42

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0571-6_42

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0570-9

  • Online ISBN: 978-88-470-0571-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics