Intensive Care Unit (ICU) Outcomes

Intensive Care Unit Staffing

  • Retrospective Study of the Addition of Nighttime Intensivist Staffing to Daytime Intensivist Staffing in 49 Intensive Care Units Participating in the APACHE Clinical Information System (NEJM, 2012) [MEDLINE]: data were adjusted for case mix, severity of illness, and daytime intensivist staffing
    • Main Findings
      • In ICU’s with Low-Intensity Daytime Intensivist Staffing: the addition of nighttime intensivist staffing decreased mortality rates
      • In ICU’s with High-Intensity Daytime Intensivist Staffing: the addition of nighttime intensivist staffing had no mortality benefit
    • Problems with the Study: study did not examine the iatrogenic complication rates, ICU cost, or ICU length of stay

Intensive Care Unit Bundles

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  • Critical care bundles and grouped orders with reminders have been found to be an effective strategy to improve patient outcomes. These measures have been associated with a decrease in central line duration and infection rate, a decrease in ventilator days, a decreased incidence of self-extubation, and a decreased incidence of VAP.

References

Intensive Care Unit Staffing

  • Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med 2012;366:2093-2101 [MEDLINE]
  • Intensive enough. N Engl J Med 2012;366:2124-2125 [MEDLINE]

Intensive Care Unit Bundles

  • Decreasing ventilator-associated pneumonia in a trauma ICU. J Trauma 2006;61:122 [MEDLINE]
  • Intensive care unit quality improvement: A how-to guide for the interdisciplinary team. Crit Care Med 2006;34:211 [MEDLINE]
  • Measurable outcomes of quality improvement in the trauma intensive care unit: The impact of a daily quality rounding checklist. J Trauma 2008;64:22 [MEDLINE]
  • Patient flow variability and unplanned readmissions to an intensive care unit. Crit Care Med 2009;37:2882-87 [MEDLINE]