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Quality Improvement in Critical Care

Quality Improvement in Critical Care. The value of teamwork. Improving Patient Safety in Critical Care. The value of teamwork. Creating and teaching an ICU manager. Financial management (including “control”) Strategic management Leadership Communication skills Human resources.

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Quality Improvement in Critical Care

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  1. Quality Improvement in Critical Care The value of teamwork

  2. Improving Patient Safety in Critical Care The value of teamwork

  3. Creating and teaching an ICU manager • Financial management (including “control”) • Strategic management • Leadership • Communication skills • Human resources

  4. “Doctor, tell me how well we are doing with regards to the AHRQ document and the practices that improve patient safety?”

  5. Processes INPUT OUTPUT Accountability

  6. AHRQ Report on Patient Safety  • -blockers in high risk operative patients • DVT prophylaxis • Feeding (enteral; parenteral), • Skin management, • Antibiotic impregnated CV catheters, • Consentable procedures     

  7. Information Processes INPUT OUTPUT

  8. What are we doing now? Management Basics • Utilization review • How well are we doing? • Benchmarking

  9. "How to" Benchmark • Using primary data acquisition to evaluate outcomes • Clinical trials • Surveillance studies • Using primary data acquisition for other questions • Registries and data banks • Summarizing existing information • Literature reviews • Meta-analysis • Group Judgment • Consensus conference • Mathematical modeling

  10. Information Processes INPUT OUTPUT Intervention Change

  11. What are we doing now? Management Basics • Utilization review • How well are we doing? • Benchmarking • Change, U.M. and Translating • How to improve? • Evaluation • Did we achieve desired change?

  12. Overall, What Changes Clinical Practice ? • Most interventions effective under some circumstances - none effective under all. • Interventions based on assessment of barriers are more likely to be effective • “Diagnostic analysis” • Multi-faceted interventions more effective • Educational outreach and reminder systems appear promising

  13. Networking to Integrate…. Hospitals • Research Expertise • Summary Reports • Educational Sessions • Practical Advice • Questions • Feedback on Studies • Insight • Data Core Support Team

  14. Barriers to Good Decision Making Performance of an individual or team is a function of, and determined by , P = M x C B Where: P = performance M = motivation C = competence B = barriers

  15. QI

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