Advertisement

Optimization of Limited Resources and Patient Safety

  • A. O. Gallesio

Abstract

A rational resource allocation is today an imperative for intensive care medicine; resource allocation, in the intensive care unit (ICU) context, is more related to human resources availability and organization, mainly the number of trained nurses, than technology and supplies. For optimizing resources we must focus on redesigning and improving work processes. Adverse events and medical errors have arisen as a formidable problem since November, 1999, when the US Institute of Medicine released a report on medical error, “To Err is Human;” this publication was followed by several studies [1, 2, 3, 4]. Technology complexity has improved patient prognosis but also has increased exponentially the possibility of errors and adverse events.

Keywords

Intensive Care Unit Medical Error Cardiac Intensive Care Unit Therapeutic Intervention Scoring System Intensive Care Unit Director 
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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kohn LT, Corrigan JM, Donaldson MS (eds) (1999) To err is human. Building a safer health system. National Academy Press, Washington, DCGoogle Scholar
  2. 2.
    Wu A (2000) Medical error: the second victim. BMJ 320:726–727CrossRefPubMedGoogle Scholar
  3. 3.
    Leape LL, Berwick DM (2000) Safe health care: are we up to it? BMJ 320:725–726CrossRefPubMedGoogle Scholar
  4. 4.
    Smith R, Hiatt H, Berwick D (1999) Shared ethical principles for everybody in health care: a working draft from the Tavistock Group. BMJ 318:248–251PubMedGoogle Scholar
  5. 5.
    ATS Bioethics Task Force (1997) Fair allocation of intensive care unit resources. Am J Respir Crit Care Med 156:1282–1301Google Scholar
  6. 7.
    Martin W, Dünser MD, Inipavudu B et al (2006) A review and analysis of intensive care medicine in the least developed countries. Crit Care Med 34:1234–1242CrossRefGoogle Scholar
  7. 8.
    Hanson CW, Deustshman CS, Anderson HL et al (1999) Effects of organized critical care services on outcomes and resources utilization: a cohort study. Crit Care Med 27:270–274CrossRefPubMedGoogle Scholar
  8. 9.
    Overview of the Nursing Workforce in Latin America. Fijar numero:http://www.paho.org/English/DD/PIN/ptoday18_sep05.htmAcceded 13/04/2009Google Scholar
  9. 10.
    What is Behind Hrsa’s Projected Supply, Demand, and Shortage of Registered Nurses? ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf Acceded 8/04/2009Google Scholar
  10. 12.
    Williams G, Schmollgruber S, Alberto L (2006) Consensus Forum: worldwide guidelines on the critical care nursing workforce and education standards. Crit Care Clin 22:393–406CrossRefPubMedGoogle Scholar
  11. 13.
    Williams GF (1997) Labour force planning and policy development: issues for nursing. Aust Crit Care 10:43–46CrossRefPubMedGoogle Scholar
  12. 14.
    Stechmiller JK (2002) The nursing shortage in acute and critical care settings. AACN Clinical Issues. Adv Pract Acute Crit Care 13:577–584CrossRefGoogle Scholar
  13. 15.
    Scribante J, Schmollgruber S, Nel E (2004) Perspectives on critical care nursing: South Africa. Connect. World Crit Care Nurs 3:111–115Google Scholar
  14. 16.
    Albarran J, Scholes J (2005) Blurred, blended or disappearing: the image of critical care nursing. Nurs Crit Care 10:1–3CrossRefPubMedGoogle Scholar
  15. 17.
    Williams G, Chaboyer W, Thornsteindottir R et al (2001) World wide overview of critical care nursing organizations and their activities. Int Nurs Rev 48:208–217CrossRefPubMedGoogle Scholar
  16. 18.
    Cullen DJ, Civetta JM, Briggs BA et al (1974) Therapeutic Intervention Scoring System: a method of quantitative comparision of patient care. Crit Care Med 2:57–60PubMedGoogle Scholar
  17. 19.
    Miranda DR et al (1996) Simplified Therapeutic Intervention Scoring System: The TISS-28 items. Results from a multicenter study. Crit Care Med 24:64–73CrossRefPubMedGoogle Scholar
  18. 20.
    Moreno R, Morais P (1997) Validation of the simplified therapeutic intervention scoring system on an independent database. Intensive Care Med 23:640–644CrossRefPubMedGoogle Scholar
  19. 21.
    Miranda DR, Nap R, de Rijk A et al (2003) Nursing activities score. Crit Care Med 2003 31:374–382CrossRefPubMedGoogle Scholar
  20. 22.
    Hanson CW, Deustshman CS, Anderson HL et al (1999) Effects of organized critical care services on outcomes and resources utilization: a cohort study. Crit Care Med 27:270–274CrossRefPubMedGoogle Scholar
  21. 23.
    Weber RJ, Kane SL, Oriolo VA (2003) Impact of intensive care unit (ICU) drug use on hospital costs: a descriptive analysis, with recomeendations for optimizing ICU pharmacotherapy. Crit Care Med 31 (Suppl):S17–S24CrossRefPubMedGoogle Scholar
  22. 24.
    Shah ND, Vermeulen LC, Santell JP et al (1993) Projecting future drug expenditure. Am J Hosp Pharm S6–S8Google Scholar
  23. 25.
    Pierpaoli PG (1993) The rising costs of pharmaceuticals: a director of pharmacy’s perspective. Am J Hosp Pharm 50:S6–S8PubMedGoogle Scholar
  24. 26.
    Rothschild JM, Landrigan CP, Cronin JWD et al (2005) The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 33:1694–1700CrossRefPubMedGoogle Scholar
  25. 27.
    Valentin A, Capuzzo M, Guidet B et al (2006) Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Med 32:1591–1598CrossRefPubMedGoogle Scholar
  26. 28.
    Vincent JL, Moreno R, Takala J et al, on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine (1996) the SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  27. 29.
    Miranda DR, Moreno R, Iapichino G (1997) Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 23:760–765CrossRefGoogle Scholar
  28. 30.
    Kaushal R, Bates D, Franz C (2007) Costs of adverse events in intensive care units. Crit Care Med 35:2479–2483CrossRefPubMedGoogle Scholar
  29. 31.
    Gallesio AO (2008) Improving quality and safety in the ICU: a challenge for the next years. Curr Opin Crit Care 14:700–707CrossRefPubMedGoogle Scholar
  30. 32.
    Smith R, Hiatt H, Berwick D (1999) Shared ethical principles for everybody in health care: A working draft from the Tavistock Group. BMJ 318:248–251PubMedGoogle Scholar
  31. 33.
    Singer PA (2000) Recent advances: Medical ethics. BMJ 321:282–285CrossRefPubMedGoogle Scholar
  32. 34.
    Leape LL, Berwick DM (2000) Safe health care: are we up to it? BMJ 320:725–726CrossRefPubMedGoogle Scholar
  33. 35.
    Smith R, Hiatt H, Berwick D (1999) PatShared ethical principles for everybody inhealth care: A working draft from the Tavistock Group. BMJ 318:248–251PubMedGoogle Scholar
  34. 36.
    Reinertsen JL (2000) Let’s talk about error. BMJ 320:730CrossRefPubMedGoogle Scholar
  35. 37.
    Society of Critical Care Medicine (1993) A model for technology assessment applied to pulse oximetry. Crit Care Med 21:615CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • A. O. Gallesio
    • 1
  1. 1.Department of Intensive CareHospital Italiano de Buenos AiresBuenos AiresArgentina

Personalised recommendations