Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team*
Critical Care MedicinePublished 22 December 2005
J. Randall Curtis, Richard J. Cook, Richard J. Wall, Derek C. Angus, Julian Bion, Robert M. Kacmarek
Citations366
SJR quartileQ1
SJR score2.12
SNIP2.15
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TL;DR
This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach and identifies four steps for evaluating and maintaining this program.
Abstract
This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.
Keywords
MedicineEconomics, Econometrics and FinanceHealth Professions
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PubMedThe seven pillars of quality.
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International Journal for Quality in Health CareThe advantages and disadvantages of process-based measures of health care quality
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BMJ Quality & SafetyEvaluation of the culture of safety: survey of clinicians and managers in an academic medical center
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International Journal for Quality in Health CareMethodology Matters. From a process of care to a measure: the development and testing of a quality indicator
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The LancetHow can clinicians measure safety and quality in acute care?
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Annals of Internal MedicineBuilding Measurement and Data Collection into Medical Practice
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The LancetChallenges in the care of the acutely ill
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Intensive Care MedicineThe importance of technology for achieving superior outcomes from intensive care
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The Joint Commission Journal on Quality ImprovementUsing the Online and Offline Change Model to Improve Efficiency for Fast-Track Patients in an Emergency Department
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