Relevant bibliographies by topics / Quality care in intensive care units

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Academic literature on the topic 'Quality care in intensive care units'

Author: Grafiati
Published: 11 December 2022
Last updated: 19 July 2025

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Journal articles on the topic "Quality care in intensive care units"

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Carlet, Jean. "Quality assessment of intensive care units." Current Opinion in Critical Care 2, no. 4 (1996): 319–25. http://dx.doi.org/10.1097/00075198-199608000-00013.

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Garcia, Paulo Carlos, Daisy Maria Rizatto Tronchin, and Fernanda Maria Togeiro Fugulin. "Care time and quality indicators in Intensive Care Units." Revista Brasileira de Enfermagem 72, suppl 1 (2019): 166–72. http://dx.doi.org/10.1590/0034-7167-2018-0067.

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ABSTRACT Objective: To verify the correlation between nursing care time and care quality indicators. Method: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. Results: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. Conclusion: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.
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Młynarska, Agnieszka, Anna Krawuczka, Ewelina Kolarczyk, and Izabella Uchmanowicz. "Rationing of Nursing Care in Intensive Care Units." International Journal of Environmental Research and Public Health 17, no. 19 (2020): 6944. http://dx.doi.org/10.3390/ijerph17196944.

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The nursing practice refers to a wide range of tasks and responsibilities. In a situation where there is a problem of limited resources, nurses are forced to ration the patient’s care—that is, minimize and skip some tasks. The main purpose of this work was to assess the rationing level of nursing care among staff in the intensive care units. Methods: The research included 150 anaesthesiological nurses in the Silesian Region in Poland. The research was conducted from July to October 2019 using the standardized Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on rationing nursing care, assessing the quality of patient care, and job satisfaction. The Modified Fatigue Impact Scale (MFIS) standardized questionnaire was used to assess the level of fatigue of respondents in the physical, cognitive, and psychosocial spheres. Results: Sociodemographic factors, such as gender, age, place of residence, education, seniority, and type of employment were not found to affect the rationing level of nursing care in the intensive care unit. The average quality of patient care was 6.05/10 points, while the average job satisfaction rating was 7.13/10 points. Analysis of the MFIS questionnaire showed that respondents experienced fatigue between “rare” and “sometimes”, and nursing staff fatigue was the main factor for rationing care. Conclusions: The higher the level of fatigue, the greater the rationing of care and the less satisfaction from work.
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Kim, Eun Sun. "Quality Improvement in Neonatal Intensive Care Units." Neonatal Medicine 25, no. 2 (2018): 53–57. http://dx.doi.org/10.5385/nm.2018.25.2.53.

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Nagamatsu, Soichiro. "Quality Improvement Interventions in Intensive Care Units." JAMA 305, no. 17 (2011): 1764. http://dx.doi.org/10.1001/jama.2011.558.

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Allen Furr, L., Catherine J. Binkley, Cynthia McCurren, and Ruth Carrico. "Factors affecting quality of oral care in intensive care units." Journal of Advanced Nursing 48, no. 5 (2004): 454–62. http://dx.doi.org/10.1111/j.1365-2648.2004.03228.x.

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Kan, B. D. "Quality of care and mortality in pediatric intensive care units." JAMA: The Journal of the American Medical Association 273, no. 16 (1995): 1258b—1258. http://dx.doi.org/10.1001/jama.273.16.1258b.

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Kan, Brian D. "Quality of Care and Mortality in Pediatric Intensive Care Units." JAMA: The Journal of the American Medical Association 273, no. 16 (1995): 1258. http://dx.doi.org/10.1001/jama.1995.03520400028034.

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Green, Thomas P. "Quality of Care and Mortality in Pediatric Intensive Care Units." JAMA: The Journal of the American Medical Association 273, no. 16 (1995): 1258. http://dx.doi.org/10.1001/jama.1995.03520400028035.

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Daraghmeh, Hameed, Ahmad Ayed, Basma Salameh, and Imad Fashafsheh. "Factors of Missed Nursing Care in Intensive Care Units." Critical Care Nursing Quarterly 47, no. 1 (2024): 62–70. http://dx.doi.org/10.1097/cnq.0000000000000494.

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Maintaining a high standard of nursing care is imperative for ensuring patient safety. Several factors significantly impact the provision of nursing care, including work environment resources, personnel coordination, work systems, and head nurse leadership. In addition, each nurse's clinical and academic career also plays a role in shaping the quality of care provided to patients. This article reports results of a cross-sectional study aimed to identify the different types of missed nursing care and the factors that contribute to them, as perceived by nurses, and second, to investigate how nurses' characteristics may relate to the occurrence of missed nursing care. Data for this study were obtained through a self-administered questionnaire that was distributed to participants working in an intensive care unit. The study included a final sample size of 176 participants, all of whom worked in intensive care unit hospitals located in the north region of Palestine. The study found that handwashing, setting up meals for patients who feed themselves, discharge planning, and response to a call light were the most frequently missed nursing care activities. The primary factors identified as reasons for missed nursing care were inadequate availability of labor and material resources, along with communication issues. Efforts to address these identified issues can potentially lead to improved quality of nursing care in intensive care units.
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Dissertations / Theses on the topic "Quality care in intensive care units"

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Alalyani, Mesheil M. "Factors influencing the quality of nursing care in an intensive care unit in Saudi Arabia." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/2632.

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Quality care in intensive care units is expected by patients and is mandatory for nurses and other health professionals to provide. In Saudi Arabia, the demand for intensive care units (ICUs) is growing rapidly, partly due to the high levels of road trauma and a population increase. In response to these issues, the government has increased the number of ICU beds in some public tertiary regional hospitals. A corresponding increase in patients and a shortage of specialized nurses has major implications for nurses’ ability to provide quality care. In the Western world there is comprehensive literature related to research and factors that influence nursing care. To date, however, no such study has been conducted in an ICU in Saudi Arabia. The purpose of this study was, therefore, to explore and describe factors that influence nursing care in a Saudi Arabian ICU. Additionally, since clinical governance has been described as a structured system for promoting quality care and health service planning, a further aim was to describe the findings within this framework.This study employed a single exploratory descriptive case study using a qualitative approach. Data were collected from various sources with thematic analysis being used to establish themes that emerged from the data. The proposition taken in this case study was that multiple factors influence the quality care registered nurses provide in an ICU setting. It was an assumption that these factors would be both internal and external to the ICU. Findings from this study concurred with this assumption uncovering multiple, complex and interrelated factors that influenced the quality of nursing care in the ICU. It also uncovered factors which were located in the conduit between the internal and external environment: namely intermediate factors. The environment was seen as: direct factors that immediately affected nurses and their ability to provide quality care; intermediate factors were those that encapsulated regular, but intermittent elements; and indirect factors related to elements external to the ICU. Within each of these categories themes and sub-themes emerged. Themes in the direct factors were Continuance: with sub themes of Shift work arrangement, Workload, Collegiality, and Unit management. Burden of responsibility: with sub themes of Educational preparation and Availability of Resources. Proximity: emerged as a theme which related to being close contact with patients.Themes in the intermediate factors were: Relationships with superiors, as well as Policies and protocols. Themes in the indirect factors were: Leadership and bureaucracy, Quality management, and Ongoing education. Together these factors had a profound influence on the quality of nursing care in the ICU. Some had distinctive characteristics whilst others overlapped and were interrelated clarifying and explaining aspects of the complex open system in which nursing care was provided. It is anticipated that these findings will not only have relevance to the ICU in the setting, but also to other hospitals in the Saudi Arabian health care system.
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Wallace, Amanda. "Effects of Telemedicine in the Intensive Care Unit on Quality of Care." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1612.

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The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, increase staff satisfaction, and increase compliance with best practices. The diffusion of innovation theory was used to bring about successful change among team members in the ICU. The Focus Plan, Do, Study, Act methodology was used to determine what improvements were needed in the ICU. The evaluation of the telemedicine unit demonstrated early signs of positive progress. Actual length of stay (3.25 days) from the hospital's telemedicine dashboard was less than the predicted length of stay (3.8 days), and adherence to best practice was at or above target (95%) when compared to all telemedicine units across the nation, as provided by the telemedicine dashboard. Implementing a telemedicine unit will bring about a transparency and standardization of Intensive Care services, leading to positive social change in the organization. This social change, combined with the success of the unit, can influence other non-academic healthcare institutions to pursue telemedicine technology.
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Mosavian, Pour Mir Kaber. "Learning and quality improvement : nursing in the pediatric intensive care unit." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63141.

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Maintaining a high quality of care in a Pediatric Intensive Care Unit (PICU) is a constant challenge. Continual 24/7 staffing, ongoing staff turnover, and the constant introduction of new equipment and procedures in a highly technologically-dependent unit requires continuous learning to deliver and improve the quality of children’s care. While all staff consider continuous learning important to maintaining and improving care, learning as quality improvement is made most explicit when new nursing staff are hired and incorporated into the PICU. In this dissertation, I investigated the process of learning by individuals in the interactive social environment of the PICU to answer the following questions: How does learning occur among the newly hired nurses in the PICU? And, how does learning contribute to quality improvement? In this mixed method inquiry, I employed ethnography, Social Network Analysis and simple descriptive and inferential statistical methods to explore process of learning among the newly hired nurses in Western Canada Hospital. I found that learning among newly hired nurses happened through face to face interactions in the context of two main activities: Orientation sessions and their Preceptorship. The most significant learning for the newly hired nurses, however, happened during their Preceptorship. Learning in the Preceptorship was social and experiential as they moved from legitimate peripheral participation in the multi-disciplinary and complementary social environment of the PICU into full participation as members of the PICU Community of Practice (CoP). This learning required the transformation and development of their individual and collective identity, as their preceptors, fellow nurses, and other staff employed scaffolding to mentor them through their constantly evolving Zone of Proximal Development (ZPD). Social and experiential learning activities became the basis for continuous quality improvement (CQI). I conclude that, in the PICU, quality improvement is the tangible manifestation and product of social and experiential learning. Rather than a sequence of corrective actions, in its most effective form, quality of care is improved through scaffolded ongoing learning activities in the authentic setting of a CoP. I recommend the unit to adopt a “learning together” sociocultural approach with scaffolding as key component for successful learning and CQI.<br>Medicine, Faculty of<br>Experimental Medicine, Division of<br>Medicine, Department of<br>Graduate
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Naidoo, Melissa. "Family and patient perception of physiotherapy care rendered to patients in the cardiothoracic intensive care unit." University of the Western Cape, 2018. http://hdl.handle.net/11394/6978.

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Magister Artium - MA<br>Background: Physiotherapists are involved in the management of patients in the cardiothoracic Intensive Care Unit (ICU). Patient and family perception of care has become an important measure in evaluating the quality of care, including care in the intensive care setting. Overall Aim: To explore and describe the family and patient perception of physiotherapy care rendered in a public sector cardiothoracic ICU in the Western Cape, South Africa. Method: This study was conducted in two phases. Phase 1 (scoping review) identified and described available outcomes for measuring family perception of ICU care by searching six databases from inception to the 20th June 2018. Results from the scoping review informed the discussion schedule for the first primary study of Phase 2. Phase 2 (two exploratory descriptive qualitative primary studies) explored and described i) family perception and ii) patient perception of physiotherapy care in a cardiothoracic ICU. Audio-taped, individual face to face semi-structured interviews were conducted with family and patient participants that met the inclusion and exclusion sampling criteria (purposive sampling). Data was transcribed verbatim and analysed using deductive-inductive thematic content analysis. The data was coded, categorised and themes were generated. Trustworthiness of the data was ensured through methods addressing credibility, dependability, confirmability and transferability. Results: A total of ten full text studies were included in the scoping review. Included studies were published between 2006 and 2017, were conducted in both developed and developing countries, in different ICUs (except cardiothoracic ICU)and all used different quantitative outcome measures to measure family perception of ICU care. Thirteen cardiothoracic ICU patients and their respective family members partook in the studies describing patient and family perception of cardiothoracic ICU physiotherapy care. The median patient age was 62 years; the mean ICU length of stay 6 days and the median family age was 55. Themes arising from the family perception of care data analysed included: i) understanding of physiotherapy care (the role of the physiotherapist, perceived benefit of physiotherapy and communication), family involvement in physiotherapy care (physical presence during physiotherapy sessions and decision-making), and satisfaction of physiotherapy ICU care. Themes arising from patient perception of care data analysed included: i) Physiotherapy management of patients, ii) The Physiotherapists – skill, iii) knowledge and professionalism, iv) Continuity of Care, v) Tangibility, vi) Physiotherapy benefits, vii) Decision-Making, viii) Communication, ix) Satisfaction of Physiotherapy ICU care. Overall, family and patients were satisfied with the physiotherapy care in the cardiothoracic ICU. However, there were areas of improvement such as the understanding of physiotherapy care, communication, family involvement in the physiotherapy care and decision-making. Conclusion: While there are multiple quantitative measures for measuring family perception of ICU care there is no “gold” standard measure that has been identified. A qualitative measure and research design would allow richer in-depth information on family perception of ICU care. The findings from the family and patient perception of cardiothoracic ICU physiotherapy care are influenced by many factors. While family and patients perceive cardiothoracic ICU physiotherapy care both positively and negatively, the majority of patient and family were satisfied overall with the care the patient received. Family perception of ICU physiotherapy care should be evaluated in order to identify areas for improvement in quality of care and could add to the body of evidence in ICU physiotherapy practice.
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Orwelius, Lotti. "Health related quality of life in adult former intensive care unit patients." Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17829.

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Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients. Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group. Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay. Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.
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Sten, Lilly-Mari. "Understanding How to Improve Team Collaboration Within Intensive Care Unit Transitional Care from the Perspective of Quality Management." Licentiate thesis, Mittuniversitetet, Institutionen för kvalitets- och maskinteknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-41985.

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Team collaboration is a fundamental part of Quality Management (QM), and working together successfully is an important part of improving an organization. Team collaboration is also essential for achieving quality of care, patient safety and care continuity, especially when handling critically ill patients. Transferring a patient from an intensive care unit (ICU) to a general ward demands planning, communication, competence, a system view, and a quality culture. This patient transfer process, called ICU transitional care, extends across hospital boundaries, which have different organizational cultures, technologies, and knowledge. It is a challenge to manage these differences in order for team collaboration to meet the needs of patients, relatives and co-workers. To achieve this, further research is required to understand how care teams, both within hospital units and between organizational boundaries, can collaborate more successfully and efficiently to achieve quality of care in the ICU transitional care process. The overall purpose of this thesis is to contribute to a deeper understanding of how to improve team collaboration within ICU transitional care aiming to increase quality of care. To achieve this, four research questions were formulated and three case studies conducted. In the first case, a systematic literature review was performed to explore the extent to which Quality Management and Nursing Science can offer complementary perspectives to provide better quality of care by looking at Quality Management core concepts and tools. Findings from this study revealed, among other things, a need for further research on team collaboration in ICU transitional care. The purpose of the second study was to develop and test a questionnaire aiming to measure the perception of team collaboration in the patient transfer process from the ICU to the general ward. This study also aimed to analyze the results to see how the questionnaire could help improve team collaboration within ICU transitional care. Empirical data were collected from two ICUs at two hospitals. Participants at the ICUs answered the developed questionnaire, and the results showed that it could be used for measuring perceived team collaboration in this patient transfer process. The results from the questionnaire also gave insights that might be useful for improving team collaboration in this ICU transitional care process. The purposes of the third study were, first, to describe how co-workers’, within a team, perceived team collaboration in patient transfers from ICU to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Focus group discussions (FGDs) were conducted at two hospitals to answer the two questions. There were several findings from the study, and the results indicated that team collaboration has an important role when creating prerequisites for a holistic view of the process, and that there was a perceived need among the co-workers to improve team collaboration over organizational boundaries. Co-workers also expressed a need for more involving patients and relatives when improving team collaboration.   Four overarching conclusions can be drawn from this research. Firstly, Quality Management is used in ICU transitional care to improve the quality of care. Secondly, multi-professional team collaboration is perceived to be easier and better developed within hospital units than between them. Collaborating in teams between hospital units is challenging for several reasons. Some reasons are unclarity in routines for communication and decision-making, for example who decides what.  A third conclusion is the importance of how teams and team collaboration are defined and structured in ICU transitional care. This involves roles and responsibilities of teams. Teams have specific characteristics that are important for their performance. A fourth conclusion is an expressed need to involve patients and relatives more when it comes to improve team collaboration in ICU transitional care. The main findings from the three studies presented in this thesis have given insight and deeper understanding of how co-workers perceive team collaboration within ICU transitional care at two hospitals located in Sweden, and co-workers’ suggestions for how team collaboration can be improved aiming to increase quality of care.<br><p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 3 (inskickat).</p><p>At the time of the defence the following paper was unpublished: paper 3 (submitted).</p>
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Ross, Purdie La Von Michelle. "Sleep Deprivation in the Intensive Care Unit: Lowering Elective Intervention Times." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7733.

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Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.
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Karachi, Farhana. "Survival and health related quality of life of patients 12 months following discharge from an adult surgical intensive care unit /." Link to the online version, 2006. http://hdl.handle.net/10019/85.

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Karachi, Farhana. "Survival and health related quality of life of patients 12 months following discharge from an adult surgical intensive care unit." Thesis, Stellenbosch : University of Stellenbosch, 2005. http://hdl.handle.net/10019.1/1868.

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Thesis (MScPhysio(Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2005.<br>Objectives: This study forms part of a baseline study conducted on patients admitted to an adult surgical ICU between June and October 2003. The survival rate and health related quality of life (HRQoL) of patients 12months following ICU discharge was determined. The correlation of selected demographic and ICU variables to survival and HRQoL was determined. Design: Prospective observational cohort study. Setting: Tenbed closed public tertiary adult surgical ICU. Patients: 180 subjects obtained from a previous baseline study. Measurements: The baseline study provided the demographic data and ICU variables. Survival rate was determined from a Kaplan Meier survival curve. A self-developed questionnaire was used to obtain other selected variables for comparison. A modified Short-Form 36 version 2 (SF-36v2) was use to measure HRQoL perceptions of patients. Results: The survival rate was 62% at 12 months following ICU admission. None of the selected variables were significantly correlated to the long-term survival outcome except for APACHE II which was negatively correlated to this outcome (p<0.01). Forty-six subjects took part in the HRQoL study. The mean HRQoL scores ranged between 43% and 53% for each of the SF-36 HRQoL domains. The physical functioning (43.5%), role play (44.5%) and role emotion (43.1%) domains had the lowest scores. APACHE II had a significantly negative correlation to the physical functioning domain of HRQoL (p=0.02). Age was positively correlated to social functioning (p<0.01) and role emotion (p=0.03). Patients employed after ICU had significantly higher scores for general health (p<0.01) than those who were not. Patients unsure of their TB status and HIV status had significantly lower scores in general health (p=0.02) and role emotion (p=0.05) respectively. ICU length of stay was negatively correlated to role play (p=0.05) and role emotion (p<0.01). Intubation period was negatively correlated to general health (p=0.04). Conclusion: APACHE II was the only variable significantly correlated to both long-term survival and the physical functioning domain of HRQoL. Although the long-term survival was comparable to that of international ICU populations the HRQoL outcomes were slightly lower. Similar to international studies and a South African study evaluating the HRQoL of aids sufferers and police, the current ICU population presented more limitation in the physical functioning, role play and role emotion domains of HRQoL.
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Lindberg, Eva. "Continouos quality development by means of new understanding : a four year study on an intensive care unit during times of hard work and demanding organisational changes /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3782.

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Books on the topic "Quality care in intensive care units"

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Joint Commission on Accreditation of Healthcare Organizations., ed. How to prepare for a survey: Special care units. Joint Commission on Accreditation of Healthcare Organizations, 1992.

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Thornton, Judith. ICU nursing monitor: an audit of the quality of nursing care for patients in intensive care units. Gale Centre, 1992.

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United States. Department of Veterans Affairs. Office of Inspector General. Healthcare inspection: Quality of care in the intensive care unit, VA Northern Indiana Health Care System, Fort Wayne, Indiana. Dept. of Veterans Affairs, Office of Inspector General, 2011.

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Gawande, Atul. The checklist manifesto: How to get things right. Metropolitan Books, 2010.

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Office, General Accounting. Medicare: Federal efforts to enhance patient quality of care. The Office, 1996.

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Gawande, Atul. The checklist manifesto: How to get things right. Metropolitan Books, 2010.

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M, Rippe James, ed. Intensive care medicine. 2nd ed. Little, Brown, 1991.

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Romanò, Massimo, ed. Palliative Care in Cardiac Intensive Care Units. Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-80112-0.

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S, Barie Philip, and Shires G. Tom 1925-, eds. Surgical intensive care. Little, Brown, 1993.

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E, Oh T., ed. Intensive care manual. 3rd ed. Butterworths, 1990.

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Book chapters on the topic "Quality care in intensive care units"

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Miranda, D. Reis. "Quality of Organization in Intensive Care Units." In Yearbook of Intensive Care and Emergency Medicine. Springer Berlin Heidelberg, 1997. http://dx.doi.org/10.1007/978-3-662-13450-4_73.

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Damiani, S., M. Bendinelli, and Stefano Romagnoli. "Intensive Care and Anesthesiology." In Textbook of Patient Safety and Clinical Risk Management. Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-59403-9_13.

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AbstractThe wide range of medical disciplines afferent to anesthesiology (anesthesia, perioperative care, intensive care medicine, pain therapy, and emergency medicine), carry a great, cross-specialty opportunity to influence safety and quality of patients’ care. Operating rooms and Intensive Care Units are settings burdened with a high risk of error: surgery is evolving, while the medical staff working in ICU is expected to provide high-quality care in a stressful and complex setting. It is estimated that about 1.5% of surgical interventions are complicated by critical events, but the true incidence is likely underestimated. Across medical specialties, preventable patient harm is more prevalent in the ICU.Recommendations and good practices for the safe provision of anesthesia and critical care exist and must be known and transferred into daily practice, since one of the main duties of anesthesia and critical care providers is to provide patient safety. Strategies to reduce the occurrence of medication errors, appropriate monitoring practices, equipment care and knowledge, planification and mastery of non-technical skills during emergencies, as well as designing and sustaining a healthy work environment and adopting adequate staffing policies could have an impact on patient safety and positively influence patient outcomes in this setting. The development of simulation training and cognitive aids (e.g., checklists, emergency manuals) is also changing the approach to crises and is expected to encourage a deeper cultural change.
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Miranda, D. Reis. "Auditing quality of care in the intensive care unit." In Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E. Springer Milan, 2003. http://dx.doi.org/10.1007/978-88-470-2215-7_50.

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Warren, Mary Lou. "Quality Assurance and Improvement in the Intensive Care Unit." In Oncologic Critical Care. Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-74698-2_4-1.

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Warren, Mary Lou. "Quality Assurance and Improvement in the Intensive Care Unit." In Oncologic Critical Care. Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-74588-6_4.

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Dale, Christopher, and J. Randall Curtis. "Quality Improvement in the Intensive Care Unit." In The Organization of Critical Care. Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-0811-0_7.

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Hongn, Andrea, Lucila M. Figueroa Gallo, and Juan M. Olivera. "Quality and Risk Management for Acoustic Pollution in Intensive Care Units." In IFMBE Proceedings. Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-51723-5_28.

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Cooper, David S., Darren Klugman, Angela J. Kinstler, David P. Nelson, and Stephen Muething. "The Cardiac Intensive Care Unit and Operating Room Continuum: Quality and Safety in the Cardiac Intensive Care Unit." In Pediatric and Congenital Cardiac Care. Springer London, 2014. http://dx.doi.org/10.1007/978-1-4471-6566-8_6.

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Lobdell, Kevin, Joe Mishkin, Rakesh C. Arora, and Rohan Mukund Sanjanwala. "Quality and Value in the Cardiothoracic Intensive Care Unit." In Difficult Decisions in Surgery: An Evidence-Based Approach. Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-04146-5_2.

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Akkoyun, Didem Sözütek, and Dilek Özcengiz. "Noninvasive Mechanical Ventilation Outside Intensive Care Unit. Quality Indicators." In Noninvasive Ventilation. The Essentials. Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-37796-9_11.

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Conference papers on the topic "Quality care in intensive care units"

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Lee, Yi Ying. "62 Using combined care to reduce catheter infection rates in cardiovascular intensive care units." In International Forum on Quality and Safety in Healthcare - Utrecht 2025. British Medical Journal Publishing Group, 2025. https://doi.org/10.1136/bmjoq-2025-qshu.62.

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Janeth Urrego Garzón, Adriana, Alexandra Suarez Cantor, and Adriana Carolina Silva Soche. "20-4DYV Green teams in intensive care units: alliances for life and planet." In 9th Latin American Forum on Quality and Safety in Healthcare: Technology for Equity. British Medical Journal Publishing Group, 2024. http://dx.doi.org/10.1136/bmjoq-2024-qsh.19.

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Ho, Lawrence, Ruth A. Engelberg, J. R. Curtis, et al. "Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit." In American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6859.

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Trillo, Alexandro Victor Hugo Octavio Soto, and Fabiola M. Martinez Licona. "Performance assessment of medical technology in the Intensive Care Unit based on quality indicators." In 2013 Pan American Health Care Exchanges (PAHCE). IEEE, 2013. http://dx.doi.org/10.1109/pahce.2013.6568299.

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Patil, Namrata, and Melissa Spinks. "Implementation Of Sedation/Delirium Assessment Tool In Non-Intensive Care Units - A Quality Improvement/Quality Assessment Study." In American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado. American Thoracic Society, 2011. http://dx.doi.org/10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a2603.

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Mahmood, S. A., J. Gabbard, A. Moses, K. Sheehan, A. Dharod, and J. A. Palakshappa. "Improving Goals of Care Discussion Documentation in the Medical Intensive Care Unit: A Quality Improvement Project." In American Thoracic Society 2023 International Conference, May 19-24, 2023 - Washington, DC. American Thoracic Society, 2023. http://dx.doi.org/10.1164/ajrccm-conference.2023.207.1_meetingabstracts.a2603.

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Bejona, Mary Deth, Andrin K. Antony, Abir Omar Mohd Hajjaj, and Roderic Batang Dayag. "40 Cost-conscious care, quality preserved: enhancing intensive care unit efficiency by reducing unnecessary blood investigations." In 2025 HMC/IHI Middle East Forum Abstracts. British Medical Journal Publishing Group, 2025. https://doi.org/10.1136/bmjoq-2025-ihi.40.

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Little, Anjuli, Cheryl Ethier, Sam Tirgari, Depeng Jiang, and Sangeeta Mehta. "A Patient Survey Of Sleep Quality In The Intensive Care Unit." In American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6705.

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Elshenawy, Summer, Theresa O'connor, Albert Kim, et al. "Using Quality Improvement Methodology to Reduce Sedations for Mri in a Quaternary Care Neonatal Intensive Care Unit." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.177.

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Pasztorova, Julia. "61 Increasing compliance with end-of-life care guidelines in general intensive care unit: quality improvement project." In Accepted Oral and Poster Abstract Submissions, The Palliative Care Congress, Sustaining Each Other, Growing Together, 16–17 March 2023, The Edinburgh International Conference Centre (EICC), Edinburgh, Scotland. British Medical Journal Publishing Group, 2023. http://dx.doi.org/10.1136/spcare-2023-pcc.81.

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Reports on the topic "Quality care in intensive care units"

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Wagner, Jesse, Hanan Aboumatar, and Jonathan R. Treadwell. Engaging Family Caregivers with Structured Communication for Safe Care Transitions. Agency for Healthcare Research and Quality (AHRQ), 2024. http://dx.doi.org/10.23970/ahrqepc_mhs4engaging.

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Objectives. To summarize recent relevant literature on patient safety practices (PSPs) focused on engaging family caregivers with structured communication during care transitions and assess the effectiveness of these PSPs to improve safety during care transitions. This review provides information for clinicians, health system leaders, and policymakers to better inform approaches to engaging family caregivers with structured communication to improve safety during care transitions. Methods. We followed rapid review processes provided by the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We searched PubMed, Embase, and the Cochrane Library for eligible studies published in 2010 through June 30, 2023, supplemented by targeted gray literature searches and review of reference lists in relevant systematic reviews. We used prespecified inclusion and exclusion criteria to assess relevant studies conducted in the United States that analyzed the effect of structured communication on care transitions with family caregivers. Prespecified clinical and patient-related outcomes included healthcare utilization, symptom exacerbation, quality of life, satisfaction, and unintended harms, among others. Findings. We identified 323 unique citations for possible inclusion; we assessed 86 full-text articles for inclusion. We included nine studies on effectiveness (2 randomized controlled trials, 6 pre-post studies, and 1 single-arm study) which assessed PSPs focused on discharge to home, transfers from intensive care units, and transitions from residential care. In residential treatment facility discharges, we found PSPs improved caregiver satisfaction (low strength of evidence [SOE]). We found insufficient evidence of other PSPs on any other included outcomes. Five studies detailed implementation facilitators, and two studies noted specific barriers to PSP implementation. While no studies specifically reported the resources required to implement PSPs, based on study descriptions, we identified four prominent resource considerations: (1) allocated time for pre-implementation intervention development and staff training; (2) designated time to deliver PSPs to family caregivers; (3) technology-based resources; (4) staff-expertise/addition training for designated roles. None of the studies reported rates of unintended harms. Conclusions. Clear communication with patients and caregivers during care transitions is important, but there is little evidence on the effectiveness of these PSPs. Included studies showed improvement in caregiver satisfaction, but more high-quality research is needed to assess the effectiveness of PSPs and unintended harms.
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Abedinov, Filip, Neda Bakalova, Plamen Krastev, Iliyan Petrov, Ralitza Marinova, and Georgy Tsaryanski. Survival and Quality of Life of Patients with a Prolonged Stay in the Intensive Care Unit after Cardiac Surgeries – Remote Results. "Prof. Marin Drinov" Publishing House of Bulgarian Academy of Sciences, 2019. http://dx.doi.org/10.7546/crabs.2019.08.16.

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Patton, Amy, Kylie Dunavan, Kyla Key, Steffani Takahashi, Kathryn Tenner, and Megan Wilson. Reducing Stress, Anxiety, and Depression for NICU Parents. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/chp.mot2.2021.0012.

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This project aims to appraise evidence of the effectiveness of various practices on reducing stress, anxiety, and depression among parents of infants in the neonatal intensive care unit (NICU). The project contains six research articles from both national and international journals. Study designs include one meta-analysis, one randomized controlled trial, one small scale randomized controlled trial, one prospective phase lag cohort study, on pretest-posttest study, and one mixed-methods pretest-posttest study. Recommendations for effective interventions were based on best evidence discovered through quality appraisal and study outcomes. All interventions, except for educational programs and Kangaroo Care, resulted in a statistically significant reduction of either stress, anxiety, and/ or depression. Family centered care and mindfulness-based intervention reduced all barriers of interest. There is strong and high-quality evidence for the effect of Cognitive Behavioral Therapy on depression, moderate evidence for the effect of activity-based group therapy on anxiety, and promising evidence for the effect of HUG Your Baby on stress.
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James-Scott, Alisha, Rachel Savoy, Donna Lynch-Smith, and tracy McClinton. Impact of Central Line Bundle Care on Reduction of Central Line Associated-Infections: A Scoping Review. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/con.dnp.2021.0014.

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Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use. Methods A literature review was completed of nine critically appraised articles from the years 2010-2021. The association of the use of central line bundles and CLABSI rates was examined. These relationships were investigated to determine if the adherence to a central line bundle directly reduced the number of CLABSI rates in critically ill adult patients. A summary evaluation table was composed to determine the associations related to the implementation or current central line bundle care use. Results Of the study sample (N=9), all but one demonstrated a significant decrease in CLABSI rates when a central line bundle was in place. A trend towards reducing CLABSI was noted in the remaining article, a randomized controlled study, but the results were not significantly different. In all the other studies, a meta-analysis, randomized controlled trial, control trial, cohort or case-control studies, and quality improvement project, there was a significant improvement in CLABSI rates when utilizing a central line bundle. The extensive use of different levels of evidence provided an excellent synopsis that implementing a central line bundle care would directly affect decreasing CLABSI rates. Implications for Nursing Practice Results provided in this scoping review afforded the authors a diverse level of evidence that using a central line bundle has a direct outcome on reducing CLABSI rates. This practice can be implemented within the hospital setting as suggested by the literature review to prevent or reduce CLABSI rates. Implementing a standard central line bundle care hospital-wide helps avoid this hospital-acquired infection.
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Balk, Ethan M., Kristin J. Konnyu, Wangnan Cao, et al. Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2022. http://dx.doi.org/10.23970/ahrqepccer257.

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Background. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. Methods. We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders. Results. Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits. In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits. In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes. Conclusion. The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.
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He, Miao, Zhaoqiong Zhu, Min Jiang, Xingxing Liu, Rui Wu, and Junjie Zhou. Risk factors for postanesthetic emergence delirium in adults: A systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.1.0021.

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Review question / Objective: Patientor population: patients with emergence delirium; Exposure: anaesthesia and surgery; Control: patients with no emergence delirium; Outcome: risk factors; Study design: meta-analysis. Eligibility criteria: To ensure the quality of this meta-analysis, inclusion criteria was decided before we carried out the search. These criteria were: (a) Original researches that carried out in observational studies. (b)Adult patients who were extubated and recovered at PACU, operation room, or intensive care unit (ICU) after surgeries and anesthesia (including general and neuraxial anesthesia, peripheral nerve blocks and sedation). (c) Risk factors for delirium must be assessed with odds ratio (OR) with 95% confidence interval (CI). Researches must present the results of multivariate regression to be considered eligible for inclusion, since multivariate analysis results shall be used to identify variables eligible for meta-analysis. (d) Full-text available literatures.
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Uhl, Stacey, Shazia Mehmood Siddique, Liam McKeever, et al. Malnutrition in Hospitalized Adults: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccer249.

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Objectives. To review the association between malnutrition and clinical outcomes among hospitalized patients, evaluate effectiveness of measurement tools for malnutrition on clinical outcomes, and assess effectiveness of hospital-initiated interventions for patients diagnosed with malnutrition. Data sources. We searched electronic databases (Embase®, MEDLINE®, PubMed®, and the Cochrane Library) from January 1, 2000, to June 3, 2021. We hand-searched reference lists of relevant studies and searched for unpublished studies in ClinicalTrials.gov. Review methods. Using predefined criteria and dual review, we selected (1) existing systematic reviews (SRs) to assess the association between malnutrition and clinical outcomes, (2) randomized and non-randomized studies to evaluate the effectiveness of malnutrition tools on clinical outcomes, and (3) randomized controlled trials (RCTs) to assess effectiveness of hospital-initiated treatments for malnutrition. Clinical outcomes of interest included mortality, length of stay, 30-day readmission, quality of life, functional status, activities of daily living, hospital acquired conditions, wound healing, and discharge disposition. When appropriate, we conducted meta-analysis to quantitatively summarize study findings; otherwise, data were narratively synthesized. When available, we used pooled estimates from existing SRs to determine the association between malnutrition and clinical outcomes, and assessed the strength of evidence. Results. Six existing SRs (including 43 unique studies) provided evidence on the association between malnutrition and clinical outcomes. Low to moderate strength of evidence (SOE) showed an association between malnutrition and increased hospital mortality and prolonged hospital length of stay. This association was observed across patients hospitalized for an acute medical event requiring intensive care unit care, heart failure, and cirrhosis. Literature searches found no studies that met inclusion criteria and assessed effectiveness of measurement tools. The primary reason studies did not meet inclusion criteria is because they lacked an appropriate control group. Moderate SOE from 11 RCTs found that hospital-initiated malnutrition interventions likely reduce mortality compared with usual care among hospitalized patients diagnosed with malnutrition. Low SOE indicated that hospital-initiated malnutrition interventions may also improve quality of life compared to usual care. Conclusions. Evidence shows an association between malnutrition and increased mortality and prolonged length of hospital stay among hospitalized patients identified as malnourished. However, the strength of this association varied depending on patient population and tool used to identify malnutrition. Evidence indicates malnutrition-focused hospital-initiated interventions likely reduce mortality and may improve quality of life compared to usual care among patients diagnosed with malnutrition. Research is needed to assess the clinical utility of measurement tools for malnutrition.
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McCarthy, Sean T., Aneesa Motala, Emily Lawson, and Paul G. Shekelle. Prevention in Adults of Transmission of Infection With Multidrug-Resistant Organisms. Rapid Review. Agency for Healthcare Research and Quality (AHRQ), 2024. http://dx.doi.org/10.23970/ahrqepc_mhs4mdro.

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Objectives. This rapid review summarizes literature for patient safety practices intended to prevent and control the transmission of multidrug-resistant organisms (MDROs). Methods. We followed rapid review processes of the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We searched PubMed to identify eligible systematic reviews from 2011 to May 2023 and primary studies published from 2011 to May 2023, supplemented by targeted gray literature searches. We included literature that addressed patient safety practices intending to prevent or control transmission of MDROs which were implemented in hospitals and nursing homes and that included clinical outcomes of infection or colonization with MDROs as well as unintended consequences such as mental health effects and noninfectious adverse healthcare-associated outcomes. The protocol for the review has been registered in PROSPERO (CRD42023444973). Findings. Our search retrieved 714 citations, of which 42 articles were eligible for review. Systematic reviews, which were primarily of observational studies, included a wide variety of infection prevention and control (IPC) practices, including universal gloving, contact isolation precautions, adverse effects of patient isolation, patient and/or staff cohorting, room decontamination, patient decolonization, IPC practices specifically in nursing homes, features of organizational culture to facilitate implementation of IPC practices and the role of dedicated IPC staff. While systematic reviews were of good or fair quality, strength of evidence for the conclusions was always low or very low, due to reliance on observational studies. Decolonization strategies showed some benefit in certain populations, such as nursing home patients and patients discharging from acute care hospitalization. Universal gloving showed a small benefit in the intensive care unit. Contact isolation targeting patients colonized or infected with MDROs showed mixed effects in the literature and may be associated with mental health and noninfectious (e.g., falls and pressure ulcers) adverse effects when compared with standard precautions, though based on before/after studies in which such precautions were ceased. There was no significant evidence of benefit for patient cohorting (except possibly in outbreak settings), automated room decontamination or cleaning feedback protocols, and IPC practices in long-term settings. Infection rates may be improved when IPC practices are implemented in the context of certain logistical and staffing characteristics including a supportive organizational culture, though again strength of evidence was low. Dedicated infection prevention staff likely improve compliance with other patient safety practices, though there is little evidence of their downstream impact on rates of infection. Conclusions. Selected infection prevention and control interventions had mixed evidence for reducing healthcare-associated infection and colonization by multidrug resistant organisms. Where these practices did show benefit, they often had evidence that applied only to certain subpopulations (such as intensive care unit patients), though overall strength of evidence was low.
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Berkman, Nancy D., Eva Chang, Julie Seibert, et al. Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccer246.

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Background. In the United States, patients referred to as high-need, high-cost (HNHC) constitute a very small percentage of the patient population but account for a disproportionally high level of healthcare use and cost. Payers, health systems, and providers would like to improve the quality of care and health outcomes for HNHC patients and reduce their costly use of potentially preventable or modifiable healthcare services, including emergency department (ED) and hospital visits. Methods. We assessed evidence of criteria that identify HNHC patients (best fit framework synthesis); developed program theories on the relationship among contexts, mechanisms, and outcomes of interventions intended to change HNHC patient behaviors (realist review); and assessed the effectiveness of interventions (systematic review). We searched databases, gray literature, and other sources for evidence available from January 1, 2000, to March 4, 2021. We included quantitative and qualitative studies of HNHC patients (high healthcare use or cost) age 18 and over who received intervention services in a variety of settings. Results. We included 110 studies (117 articles). Consistent with our best fit framework, characteristics associated with HNHC include patient chronic clinical conditions, behavioral health factors including depression and substance use disorder, and social risk factors including homelessness and poverty. We also identified prior healthcare use and race as important predictors. We found limited evidence of approaches for distinguishing potentially preventable or modifiable high use from all high use. To understand how and why interventions work, we developed three program theories in our realist review that explain (1) targeting HNHC patients, (2) engaging HNHC patients, and (3) engaging care providers in these interventions. Theories identify the need for individualizing and tailoring services for HNHC patients and the importance of building trusting relationships. For our systematic review, we categorized evidence based on primary setting. We found that ED-, primary care–, and home-based care models result in reduced use of healthcare services (moderate to low strength of evidence [SOE]); ED, ambulatory intensive caring unit, and primary care-based models result in reduced costs (low SOE); and system-level transformation and telephonic/mail models do not result in changes in use or costs (low SOE). Conclusions. Patient characteristics can be used to identify patients who are potentially HNHC. Evidence focusing specifically on potentially preventable or modifiable high use was limited. Based on our program theories, we conclude that individualized and tailored patient engagement and resources to support care providers are critical to the success of interventions. Although we found evidence of intervention effectiveness in relation to cost and use, the studies identified in this review reported little information for determining why individual programs work, for whom, and when.
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Dubief, Jessie. Setting Standards of Care Quality! EURORDIS - Rare Diseases Europe, 2020. http://dx.doi.org/10.70790/igio1525.

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This report presents the results of the H-CARE Pilot Survey for the four European Reference Networks (ERNs) that initated this study conducted by Rare Barometer: ERN GENTURIS, ERKNet, ERN Lung and eUROGEN. The goal of this study was to test the feasibility of measuring rare disease patients’ and carers’ experience with the care delivered by healthcare providers who are part of an ERN. A Topic Expert Committee composed of patient representatives, clinicians and managers from ERNs GENTURIS, ERKNet, Lung and eUROGEN selected a patient reported Experience Measure (PREM) questionnaire validated for chronic conditions, the Patient Assessment of Care for Chronic Conditions Short Form (PACIC-S). This questionnaire was administered by Rare Barometer, with the participation of hospital units that were members of the four ERNs of the pilot. This report presents the results of the pilot study for the 1,319 patients and carers who assessed European healthcare providers treating rare diseases affecting kidneys, lungs, the urogenital area and genetic tumour risk syndromes: Patients had a better healthcare experience when they were treated by hospital units that are part of a ERN. The PACIC-S showed good internal consistency and good construct validity in German, French, English and Spanish. But content validity was low as all aspects of care experience for rare diseases were not covered by the scale, showing that the PACIC-S did not fully capture the healthcare experience of people living with a rare disease. Recommendations for the development and validation of a new scale for RDs include planning onsite distribution of paper questionnaires in specialised hospital units, in addition to online distribution towards patient organisations and on social media, in order to reach a sufficient number of respondents for each ERN and language.
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