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Quality Management in the ICU: Understanding the Process and Improving the Art

  • P. Murabito
  • F. Rubulotta
  • A. Gullo

Abstract

Recently clinicians, researchers, nursing-staff, economists and experts in the field of health system governance have stressed the importance of quality improvement for clinical management optimization. The advances made toward quality improvement have been marked by the ability of the team leader to ration resources and improve work through the development of guidelines and audit control. Evidence-based medicine is a modern approach for integrating current medical knowledge into clinical practice. It states that management of patients should be based on the rigorous assessment of the results of randomized controlled trials (RCTs) combined with evidence from other forms of research. This approach has merit. Variations in the management of patients can result in care of varying quality and varying mortality [1]. Critical care physicians and nurses are involved in the quality improvementprocess in accordance with the assumptions of Davidoff and Batalden: in contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance [2]. The formal version of that cycle — the Plan-Do-Study-Act model — is now a key component of medical quality improvement [3] and also includes a “Publish” step. Indeed, the biologist Edward O. Wilson has gone so far as to state that: “One of the strictures of the scientific ethos is that a discovery does not exist until it is safely reviewed and in print” [4]. Unfortunately, publication in medical quality improvement has played a limited role to date. This lack of published reports has arguably deprived the health care system of rigorous scholarly evidence on work improvement and hence has slowed the development of the improvement process [5].

Keywords

Intensive Insulin Therapy Spontaneous Breathing Trial Noninvasive Positive Pressure Ventilation Medical Emergency Team Clinical Governance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • P. Murabito
    • 1
  • F. Rubulotta
    • 1
  • A. Gullo
    • 1
  1. 1.Department of Anaesthesia and Intensive Care“Policlinico” University HospitalCataniaItaly

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