Quality management in intensive care

  • G. Williams
Conference paper


The rapid growth of intensive care services since the 1960s and 1970s has brought with it enormous advances in our capacity to save, prolong, and improve lives. Once considered “miracles”, many medical achievements are now taken for granted and the general expectation placed on intensive care practitioners is that they will continue to expand their field of competence turning “miracles” into common practice. However, continued quality improvement in this high-tech/high-touch field has lead to a cost explosion m health care that is no longer taken for granted nor expected or accepted. The “bean counters” are worried, and rightfully so. hi western countries 0.2–1.0% of gross national product is spent on intensive care services [1]. As a proportion of health care expenditure, intensive care services form a significant component of most hospital budgets [2]. We are now m the “more and less” phase of our evolution where the community expectation is for more and better services, yet they want this for a less or cheaper price.


Intensive Care Unit Professional Association Continue Quality Improvement Unit Policy Open Disclosure 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Junoy JP (1997) Measuring technical efficiency of output quality in intensive care units. Int J Health Care Qual Assur 10:117–124CrossRefGoogle Scholar
  2. 2.
    Jacobs P, Noseworthy TW (1990) National estimates of intensive care utilisation and costs: Canada and the United States Crit Care Med 18:1282Google Scholar
  3. 3.
    Englehardt HT, Rie MA (1986) Intensive care: intensive care units, scarce resources and conflicting principles of justice. JAMA 255:143Google Scholar
  4. 4.
    Shorten SM, Zimmerman JE, Gillies RR, et al (1992) Continuously improving patient care: practical lessons and an assessment tool from the National ICU study. J Qual Assur 18:150Google Scholar
  5. 5.
    Zimmerman JE, Knaus WA, Judson TA, et al (1988) Patient selection for intensive care: a comparison of New Zealand and United States hospitals. Crit Care Med 16:318PubMedCrossRefGoogle Scholar
  6. 6.
    Shorten SM, Zimmierman JE, Rousseau DM, et al (1994) The performance of Intensive care units: does good management make a difference? Med Care 32:508CrossRefGoogle Scholar
  7. 7.
    Carlson RW, Weiland DE, Srivathson K (1996) Does a full-time, 24 hour intensivist improve care and efficiency? Crit Care Med 12:525Google Scholar
  8. 8.
    Knaus WA, Draper E A, Wagner DP (1986) An evaluation of outcome from intensive care in major medical centres. Ann Intern Med 104:410PubMedCrossRefGoogle Scholar
  9. 9.
    Zimmerman JE, Shortell SM, Rousseaeu DM, et al (1993) Improving intensive care: observations based on organisational case studies in nine intensive care units: a prospective, multi centre study. Crit Care Med 21:1443–1451PubMedCrossRefGoogle Scholar
  10. 10.
    O’Connell NH, Humphreys H (2000) Intensive care unit design and environmental factors in the acquisition of infection. J Hosp Infect 45:255–262PubMedCrossRefGoogle Scholar
  11. 11.
    Park GR (1991) Fire safety in the intensive care unit. Intensive Care Society, LondonGoogle Scholar
  12. 12.
    Williams G, Clarke T (2001) A consensus driven method to measure the required number of intensive care nurses in Australia”. Aust Crit Care 14:106–115PubMedCrossRefGoogle Scholar
  13. 13.
    Baas LS, Beery TA, Hickey C (1997) Care and safety of pacemaker electrodes in intensive care and telemetry nursing units. Am J Crit Care 6:302–311PubMedGoogle Scholar
  14. 14.
    Bolyard EA, Tablan OC, Williams WW, et al (1998) Guideline for infection control in health care personnel. Am J Infect Control 26:289–354CrossRefGoogle Scholar
  15. 15.
    http://www.fic.anzca.edu.au/,www.acccn.com.auGoogle Scholar
  16. 16.
    Eddy D (1990) Practice policies — what are they? JAMA 163:877–880CrossRefGoogle Scholar
  17. 17.
    Dawson JA (1992) Managing risk, performance and information Ch. 226 in Accreditation Manual for Hospitals: Special Care Units, Chicago, Joint Commission of the Accreditation of Healthcare OrganisationsGoogle Scholar
  18. 18.
    Benbassat J, Pilpel D, Schor R (2001) Physician’s attimdes toward litigation and defensive practice: development of a scale. Behav Med 27:52–60PubMedCrossRefGoogle Scholar
  19. 19.
    Thurman AE (2001) Institutional responses to medical mistakes: ethical and legal perspectives. Kennedy Inst Ethics J 11:147–156PubMedCrossRefGoogle Scholar
  20. 20.
    Vincent JL (1998) Information in the ICU. Are we being honest with our patients? The results of a European Questionnaire. Intensive Care Med 24:1251–1256PubMedCrossRefGoogle Scholar
  21. 21.
    Rawlins R (2001) Hospital Accreditation is important. BMJ 322:674PubMedCrossRefGoogle Scholar
  22. 22.
    Acre HE (1998) Hospital accrediation as a means of achieving international quality standards in health. Int J Qual Health Care 10:469–472CrossRefGoogle Scholar
  23. 23.
    Novack DH, Detering BJ, Arnold R, et al (1989) Physicians attitudes towards using deception to resolve ethical problems. JAMA 261:2980–2986PubMedCrossRefGoogle Scholar
  24. 24.
    Serembus JF, Wolf ZR, Youngblood N (2001) Consequences of fatal medication errors for health care providers: a secondary analysis study. Med Surg Nurs 10:193Google Scholar
  25. 25.
    Green MJ, Färber NJ, Ubel PA, et al (2000) Lying to each other: when intemal medicine residents use deception with their colleagues. Arch Intern Med 160:2317–2323PubMedCrossRefGoogle Scholar
  26. 26.
    Hart E, Hazelgrove J (2001) Understanding the organisational context for adverse events in the health services: the role of cultural censorship. Qual Health Care 10: 257–262PubMedCrossRefGoogle Scholar
  27. 27.
    Herbert PC, Levin AV, Robertson G (2001) Bioethics for clinicians: disclosure of medical error. CMAJ 164: 509–513Google Scholar
  28. 28.
    Witman AB, Park DM, Hardin SB (1996) How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med 156: 2565–2569PubMedCrossRefGoogle Scholar
  29. 29.
    Bayliss F (1997) Errors in medicine: nurturing truthfulness. J Clin Ethics 8:336–341Google Scholar
  30. 30.
    McNeill PM, Walton M (2002) Medical harm and the consequences of error for doctors. Med J Aust 176:222–225PubMedGoogle Scholar
  31. 31.
    Australian Council for safety and Quality in Health Care: http://www.safetyandquality.org/Google Scholar
  32. 32.
    Australian National Open Disclosure Project: http://www.nsh.nsw.gov.au/teachre-search/cpiu/OD.htmGoogle Scholar
  33. 33.
    Kraman SS, Hamm JD (1999) Risk management: extreme honesty may be the best policy. Ann Intern Med 131: 963–967PubMedCrossRefGoogle Scholar
  34. 34.
    Pinker S (2002) Quebec moves towards full disclosure of medical errors. CMAJ 166:800PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. Williams

There are no affiliations available

Personalised recommendations